TRANSCRIPT - Highlighting Potential: A Beginners Guide to Evaluating Students with Blindness, Low Vision and Deafblindness Ð 8/26/24
 
>>Brenna: Today we're going to talk about Highlighting Potential: A Beginner's Guide to Evaluating Students with Blindness, Low Vision, and Deafblindness. I'm an educational diagnostician and I have a graduate certificate in DeafBlindness. Today we're going to explore a basic framework for approaching evaluation for students with blindness, low vision, and DeafBlindness. I hope to offer you an approach and resources that will allow you to feel more confident when you're working with this low-incidence population. Let's work together to make sure that every student's potential is recognized. A thorough and well-conducted evaluation is the foundation of developing an effective IEP. It ensures that the IEP is tailored to meet the individual needs of the student by building on their strengths and interests. I have a six-step process that we're going to talk about today. It's just a general evaluation process that you can use to approach any kind of evaluation for a child with a sensory impairment. Our first step is reviewing regulations and guidance. Our second step is establishing the multidisciplinary team. Our third step, we're going to start the RIOT but we're only going to do the RIO. The fourth step is planning assessments and ensuring accessibility. The fifth step is that T. And the sixth step is the multidisciplinary team data analysis. So reviewing regulations and guidance. When you're approaching something that you might not be familiar with, this is a really good place to start. I would suggest looking at regulations at the state level, the federal level, and as well as going to experts within the VI world. So it's important to know the eligibility criteria for a disability before you're beginning an evaluation, especially if you're the person responsible for preparing paperwork like a read or a notice of proposal to evaluate. This will ensure that the scope of the evaluation includes all of the components that are needed for eligibility consideration. The Texas Administrative Code addresses the eligibility criteria, and this information is easily accessible, as part of the Texas legal framework. So for VI eligibility, we have to have that medical eye report, the Functional Vision Evaluation, Learning Media Assessment. And if this is an evaluation to establish initial VI eligibility, an orientation and mobility evaluation is required. I also wanted to take some time to address the Deafblind criteria. There are actually four different ways to meet Deafblind criteria. Region 11 created a simple graphic that shows the four different paths. It's on the right side of the screen. So being deaf and hard of hearing and visually impaired is the most straightforward way to meet the criteria and oftentimes it's the only way that people are familiar with. It's also important to know that a child who meets criteria as VI and has a suspected hearing loss but no speech at an age where speech would be expected, per an SLP, they can be considered eligible as a student who is Deafblind. It's also important to know that students who have both documented hearing and vision losses that don't meet each individual criteria but if they are considered in combination, if that combination adversely affects the child, they may also be found eligible as Deafblind. And then lastly, students who have a documented medical diagnosis that's of a progressive nature that could impact vision and hearing, they also may be considered eligible as Deafblind. Going over to our federal regulations. Looking at information from the evaluation process. That is important for us to know walking into this evaluation that's a little bit different than things we might keep in mind. So we need to make sure that we're selecting and administering assessments that accurately reflect the child's abilities rather than only reflecting their impaired sensory skills. This is definitely something that you're going to want to keep in mind as we plan our evaluation tools later through this process. A child should be assessed in all areas related to the suspected disability, including, if appropriate, health, vision, hearing, social, emotional, general intelligence, academic performance, communicative status, and motor abilities. It may not always be appropriate to assess for general intelligence for all children within this population because we are looking for tests that are looking at what these kids can do instead of capturing what they're not able to do because of that sensory disability. There's going to be a lot of evaluator judgment that comes into play as we talk about this process. Go for guidance within the field. Check out American Printing House. This document is actually hot off the press. It is a must read. It's only 36 pages long and I promise it is worth reading. This is an update from a previous 2011 publication. It addresses eight overarching topics with 31 guidelines to keep in mind as you are going through this process. It involves valuable insights. It has best practice in mind. And this is from experts within the VI field. The graphic on the right side of the screen shows the -- what the first page of the graphic looks like. It is linked in the handout. All of the resources that I mentioned are also linked on the second page of the handout. Okay. So talking about these American Printing House topics. The eight main topics that we need to keep in mind as we are approaching this evaluation. So the first topic is examiner collaboration. The collaboration of teachers of students with visual impairments is essential for accurate assessments, as most evaluators lack specific experience in this area. Additionally, evaluators should seek consultation from colleagues within their own field who have previous experience working with students with visual impairments to help guide their test selection and interpretation of data. So a multidisciplinary team approach is required for these types of assessments, as vision loss, low vision, and blindness, it can impact many different areas of development across all domains. Our second topic addresses the ecological validity and the RIOT model. To make sure that your data is valid, if you get information from a variety of sources through a variety of different methods, you integrate this data, you're going to start seeing some patterns that are going to go beyond the standard scores and percentile ranks that we typically look for. So by reviewing records and conducting tailored interviews, observing in natural settings, and observing children test with adaptations, the evaluators can better understand that child's strengths and challenges to ensure that the evaluation reflects their true abilities. So American Printing House topic 3 and 4. We want to consider the impact of visual impairment on development. So to accurately assess development, evaluators must understand the specific visual condition. Visual impairment is not one thing, it is a variety of conditions that can manifest themselves in many different ways. So it's important that when you're working with a child, you research the specific etiology of their condition. Low vision and blindness, especially when they are congenital, can lead to delays in motor ability, language, social and daily living skills. Children often miss out on incidental learning, requiring explicit instruction to acquire concepts in language so evaluators need to make sure they're assessing the extent of the child's experiential learning and taking into consideration any kind of early interventions that they've had before we move straight to identifying additional areas of eligibility, as some of these delays could be related to a lack of visual information as opposed to a occurring disability. Topic 4 sess considerations in test selection and administration. Standardized tests are not designed with low vision blindness in mind and separate norms are widely unavailable as the population is so diverse. So evaluators need to use a lot of judgment when they are selecting tests and when they are interpreting the test results. Auditory memory and listening comprehension are going to be key areas to assess but you need to keep in mind any areas in comprehension you need to consider. Are they stemming from a lack of experience or a true cognitive deficit. So evaluators should make sure to include more verbal measures when the visual-based measures are less valid. And also keep in mind you're going to need extra time for the assessment, for breaks in the assessment, for testing adjustments to account for potential visual fatigue. This is a pretty lengthy evaluation process compared to what you may be used to for another eligibility that does not include a sensory disability. So topic 5, the considerations for Braille and tactile graphics. So Braille is a complex system. There is UEB Braille, Nemeth Braille, contracted Braille, uncontracted Braille. And these can create challenges in reading and writing. It's important that evaluators collaborate with Braille experts during the assessments to ensure accuracy in administering and interpreting results. Evaluators should verify that the child that they're working with is also proficient in tactile graphics before providing them with tactile graphics and expecting them to interpret them. As someone who did not start this journey in the VI world, it's been very interesting talking with my TDB and her just sharing with me about Braille and for instance we were talking earlier if a student was writing and for the word "go." Instead of spelling it out, if they just put G, well, that's a shorthand whole word contraction that can be used that's widely understood in UEB as meaning go. But without her support or her context, if I was to see that, I might count that incorrectly because I didn't have that depth of knowledge of Braille. So if you have any children that are going to be utilizing Braille as part of their evaluation, you are for sure going to want to take a team approach. We also need to consider the use of visual stimuli in the assessment. It may be appropriate to still use some visual stimuli based on the individual's level of vision. So the vision test results should be -- or test results that require visual processing, visual measures, they should be interpreted as a minimum estimate of that child's functioning because it may not be a true representation of their abilities. Something that I have seen in myself that I've noticed when working with people, when I have a TSVI -- yes -- check an assessment that I'm wanting to give, previously I might have only shown her the first two or three items. But as items go on, often the visual complexity increases so when we talk about later assessing that accessibility, you're going to want to make sure you review the entire assessment with your team, not just the first few items. Because that visual complexity can change on later items. Evaluators should also be cautious with timed visual tasks. They may not be reflecting the cognitive processing speed but they may, instead, be reflecting the individual's ability to manage and navigate visual tasks. So we want to be careful with our visual testing as well as our cognitive processing speed testing. Topic 7 talks about adaptations and modifications. Adaptations are changes that allow access without altering the test difficulty or what it's measuring. While modifications change the concept that's being measured. So when planning for testing, adaptations should be based on the individual's specific visual needs and they should be thoroughly documented in the evaluation report. Evaluators need to carefully differentiate between adaptations and modifications and when modifications are used, the results should be interpreted qualitatively as opposed to quantitatively. Assistive technology is also something that you can use to help the test become more accessible to the child. And it's also important to know that what is the child's individual use of assistive technology independently. You might not want to introduce a brand-new device that they have never used before on the day you're testing and expect them to use it efficiently. That wouldn't be fair. And then topic 8 talks about co-occurring conditions. When evaluating students with visual impairments, it's always important to assess for co-occurring conditions. Visual impairments may directly affect other areas of development. Or they could coexist with an unrelated condition such as autism or an intellectual disability. An evaluator needs to be specialized knowledge in both low vision and blindness and the co-occurring condition to accurately differentiate between symptoms or characteristics. Because sometimes there can be overlap, especially in complex cases that include autism and DeafBlindness. So careful consideration is required when you're interpreting standardized tests. You need to ensure that the modifications or adaptations are not compromising the validity of the assessment. And that you are interpreting the data appropriately based on if you have offered an adaptation or a modification. Okay. This book. This book is everything. You need to get a copy of this. If you have access to the laws, the APH document, and this book, 90% of what you need to know is contained in these documents. Okay? This book is called making evaluation meaningful. It is the second edition. You can buy it directly from TSBVI or you might be able to borrow it through your local Education Service Center. The first time I encountered this book, it was provided to me on loan through a nearby region. And I would suggest that you keep this book with you the entire time during an evaluation process. If you are working in a VI department, it would be wonderful if you could have this book on hand for anyone else who may be evaluating your children. Because it truly does include a wealth of information consolidated into one place that is unlike anything else. I also wanted to touch on how gracious and helpful people within this world are. I have had a lot of people go above and beyond to help me be successful in doing evaluations for these children. I have reached out to, you know, my regional service centers. And not just the closest one. One time I had two service centers over let me borrow a testing kit who let me borrow this book, who delivered it to me. And then the woman who wrote the book, marney Loftin, I e-mailed her and she gave me her cell phone number and called me. There are a lot of people out there who are invested in these children and want to give you pointers. But it is a very low-incidence population so if you're unable to get assistance within your immediate district, especially if you're in a rural area, reach out to other evaluators, other regional service centers. There is a lot of assistance out there. Two of the main things this books talks about, it talks about additional eligibilities. Any time you are considering an additional eligibility for a child who has low vision or blindness, you need to consult this book. It goes through every single area of eligibility and talks about how the impact of vision loss and blindness can manifest itself in children and some overlap characteristics you may see that you would need to keep in mind when making determinations about additional eligibilities. It also addresses underidentification, especially of gifted and talented and learning disabilities. In my own district that I work in, the test that is used for determining gifted and talented, it's not accessible to students who are blind or have low vision or who are deaf. But if you do a really good evaluation on a kid through their FIE, I have used that information to write a letter to a school counselor, to an administrator, to a parent and to get that child recognized as gifted and talented through an alternate means. It also touches on the underidentification of learning disabilities in students who have low vision and blindness. So, get the book. This is just a review of some characteristics of young children with low vision or blindness. If you're unfamiliar with children with low vision and blindness, this is definitely something you need to know walking into an evaluation so you don't perceive it as something that it's not. It's very common for these children to utilize echolalia, to have strong expressive vocabulary skills that sometimes people equate with a high IQ, as well as having limited receptive skills because they lack concepts due to lack of incidental learning. They often focus on parts over the whole and they can be passive in problem solving. Because they've had magic fairy syndrome their whole life. People will do things for them, bring things to them. We sometimes see some of that learned helplessness in this population. These children also may have delayed motor milestones. They can have a hesitancy in exploring their environment and initiating peer-to-peer social interaction. They can also have self-stimulatory behaviors. They can be very egocentric. They can have difficulty with peer interactions. There's often a resistance to transition or change. And sometimes social isolation too. So it's important to keep these characteristics in mind and some of the different developmental differences that you may see with children and with low vision and blindness. 

>>Kaycee: Brenna, this is Kaycee. We had a question about some of the information and resources that you've shared so far. And for our folks joining in from states other than Texas, how you feel like they may apply to other state's guidelines and law and also just federal, in general? 

>>Brenna: So I would say that all of this guidance for sure falls under federal regulations. I would assume that it would be an alignment with state regulations as well. I'm not an expert on the eligibility criteria of autism in other states, but there's really good guidance in this book that can be applied to the evaluation process that I'm sure would be valuable in areas outside of Texas. This is just best practice. Okay. We are on step 2, establishing our multidisciplinary team. So you need to locate your team to effectively support students with blindness and low vision. You have to have a collaborative team approach. You're going to have your key specialists, your TSVI, your O&M. If you have a diagnostician, LSSP, SLP, potentially a TDB or TDHH. And this team needs to work together in all stages of this evaluation. You need to be planning together. You could be assessing together and you could be analyzing this data together. This is not the kind of evaluation where you want to divide and conquer. It's important that you also consult with specialists who are outside of your team. This could be colleagues within your own field, regional representatives, state experts, statewide outreach people. And the graphic on the right shows my bitmoji high-fiving. You need to find a VI buddy. It's going to be essential for your success in this. If you were in this room with me and coming at this from the VI side, please go find yourself a general evaluation buddy. It just makes it better for everyone. Most importantly the kids, when we work together. Hi, Jennifer. I hope you're here. So step 3 of this is -- we're going to start this RIO, the beginning of the RIOT evaluation model. So we're going to start with a records review. We're going to look at anything we can get our hands on. If you can get a previous evaluation, that's fantastic. Current medical information, the current, hopefully just completed Functional Vision Evaluation and Learning Media Assessment. And any kind of information about assistive technology use, what the child's previous educational opportunities have been. It's also important to know that if that child has had a recent change within their learning media that they use, that is something else you will need to keep in mind. For your interviews, you're going to want to conduct interviews with people who are experts on the child. So an expert on the individual child, it can be a lot of people. It can be their family members. It can be their teachers. It could even be a paraprofessional who is in the class every day with that kid. Anyone who spends significant time with a child has the capacity to become an expert in that child. And you can gain a lot of additional insights from chatting with them. As far as observations go, it's really important to observe the child in a variety of settings across multiple bays. You want your observations to be at least 20 minutes in length and you want to be able to gather a very clear picture of that child through these observations. If at all possible, team up with your TSVI and go observe that Functional Vision Evaluation. Go observe that Learning Media Assessment. If you have never interacted with a child who has low vision or blindness, there are some things that you're not even going to consider that when you watch a TSVI work with a child you'll think, oh, okay. Like you can't just walk into a room and say, hey, put your backpack over there or get me that thing. You have to be very specific when you're talking. And that might not be something that you're used to. It's also important that if this is a child who uses a white cane for travel, do you know how to walk with that child appropriately? Is that something that you want to try and figure out alone the first time you're working with that kid? Or is that something you want to be able to observe a TSVI do and then kind of learn while you're establishing that initial rapport with the child. Step 4. We are going to plan our assessments and ensure accessibility. So this is hard for people in the evaluation world and just the general evaluation world. But to highlight potential in a student that is outside the norm, deviation is necessary. You know, a lot of people want to just show up with a stimulus book and read the backside of the book and give the same set of assessments that they do to every other kid. You cannot do that. This is a very targeted evaluation process and you're going to deviate from your norms and you're going to step outside the box a little. And it might be uncomfortable at first but it's okay. You'll get good at it. So when we are selecting assessments to use, I think there is a hierarchy of the most appropriate assessments. So first, if at all possible, if you can use a standard assessment just the way that it comes. Maybe it has some built-in adaptations. For example, KABC, Kaufman Assessment Battery for Children, there's a way you can administer the test but score it without time points. While there are visual tasks that are involved, the child is not gaining or losing any points for how long it takes them to answer. And that's not a modification of how that test is meant to be used. That's a valid option that's in the manual. It's important that when you're looking at these tests you need to see what do you have in stock and be familiar with all different ways you can use it and what the manual says. If you don't have a standard assessment that's appropriate, my next recommendation would be look at the standard assessments that you have and remember, from that previous observation, you saw that student and you were taking into consideration what kind of assistive technology do they use. Could you add the assistive technology devices that they are already familiar with to an assessment that you already have to make it appropriate? This might be something as simple as a dome magnifier or a video magnifier. Your next option could be using adapted assessments. There are assessments that are tactile, big picture, Braille. They are made this way. They are -- not every school district has them but if you reach out to your Education Service Center, they probably have a lending library. You might be able to borrow that assessment kit from them. And then, lastly, you have the option of adapting your own materials. So when you're adapting materials, remember you're only going to want to use that qualitative information. You're not going to report out scores. Also keep copyright laws in consideration. They are a thing that does apply to norm referenced standardized assessments. This is just a little sampling of some assessments that are adapted that are available. The Boehm3 is great. There is a tactile edition. The picture on the right side of the screen, it's kind of hard to see but you have these large binders and they have plastic sheets in them that have different information that's been embossed in them. It's testing for very basic concepts. So one of the pages, it has a large button, a medium button, and a small button. And through this you can ask the child which is the biggest button? Which button is in the middle? Which button -- if this one is first, which one is second? There's a lot of really good, just big-concept information that you can get from young children or children who are developmentally still gaining these skills. The Brigance comes in contracted and uncontracted. Large print. Same for key math and same for Woodcock-Johnson assessments. They have been adapted for Braille readers. Okay. So a cross-battery approach is essential when you are approaching an evaluation. You can select subtests from different assessments. You do not have to give every single subtest in a battery. Evaluators should carefully select only the subtests that are relevant and accessible. So on this screen, on the bottom there is a link to a webinar handout. I believe the webinar was done by California School for the Blind. There's like a three-hour YouTube video that goes along with it. And a 200-page document. It is fantastic. It is something that should be in your repertoire of things you know. As an evaluator, if you're familiar with the cross-battery approach, Flannigan, Ortiz, the G areas, there is a -- several pages in this handout where it looks at GF, your fluid reasoning. And it breaks it down into the different narrow bands. And in each narrow band it will tell you test, subtests that are out there, that are available that have no visual demand or very, very minimal visual demand. So if you were looking to craft a battery of, you know, assessments to get information in as many G areas as you can, you can reference this document and look at all the different G areas, all of the different subtests that are available. And they're in tests that you already have. You're probably just not thinking of the best way to use them. Also in reference to G areas, we talked about how it might not be appropriate to get a measure of, you know, overall intelligence skills. But it is still important to measure the appropriate G areas. Visual processing, probably not something we want to measure. And with processing speed often it's measured visually. But you can still get really good information from that GC, comprehension knowledge. GF, fluid reasoning. Short-term memory, long-term retrieval, and auditory processing to help guide, you know, recommendations for accommodations in instructional strategies for these kids. Fantastic handout. Absolutely worth keeping in your repertoire. So planning assessments. Now that you've kind of thought about the tools that you have and tried to pick the ones that you think are the most appropriate for the student, before you administer anything, it is crucial to ensure the accessibility, by reviewing the selected testing items with the TSBVI -- or the TSVI. Sorry. That teacher can help determine whether the materials, including Braille, large print, tactile graphics, if they're appropriate and accessible to a student. One time early on in me trying to evaluate a low vision child, I comically overly enlarged something trying to make it large print. And when I showed it to the TVI she thought it was hilarious. Don't be like me, kids, or if you are, make sure you show it to someone who is an expert in this area before you take the kid a giant handout. So collaboration is necessary to ensure that the adaptations are made in advance and that even based on these adaptations that you're able to get that accurate information for an equitable evaluation. Again, the regional service center might have tools for you to borrow. And by confirming the accessibility of the assessments you're giving, you're best able to gather valid information for the committee. For planning days and times and locations, this is something for you to take into consideration. There are probably going to be multiple evaluators working with this student and you don't want three people trying to pull on the same day. Coordinating avoids overscheduling and ensures that the student is not overwhelmed. It's important to think about where you're going to be testing the student. You want to make sure that you're minimizing distractions or any kind of visual fatigue or due to clutter in a potential background. Ideally, in an ideal world, you would have spent time with the TVI and the student together while you're observing that FVE, LMA to establish rapport. Hopefully if the child has been receiving VI services, maybe there's a location on that campus that that teacher uses regularly with that child so the child would be more comfortable going to that location. I know that if I were a kid and someone I didn't know, you know, showed up and tried to take me somewhere in a room I had never been before and do strange tasks, I probably wouldn't love it. We want to make sure we're focusing on establishing that rapport and that we're thinking about every single step in this process. And, again, if you're using a Braille assessment, schedule to administer that with an ancillary examiner who is proficient in Braille. So now we're to the T in RIOT. This is the testing part. We've talked about establishing rapport. It's crucial to first establish that rapport to make the student feel comfortable and at ease. You're going to be testing over multiple sessions, multiple days to prevent fatigue and to ensure accurate results. There might be times when you're doing a team approach to assessment. I always like teaming with teachers or other specialists as needed. It's a really good process for everyone. I think that when we work with students, sometimes the more the merrier. Sometimes people will see things that other people don't. Our last step. Multidisciplinary team data analysis. Again, back to the book. If you are considering an additional area of eligibility, please obtain guidance from a specialist and reference the book. The data that you have collected for this child's evaluation, the qualitative and quantitative data, you should analyze it together as a team. And you should collaborate during report writing. I love it when I see kids who have a cohesive, single evaluation document as opposed to an evaluation document that looks like ten different evaluations stapled on top of each other. You know what I'm talking about. So we just want to make sure we're integrating that data across all areas to form a nice cohesive document. So this is a Texas thing but it probably applies everywhere. So sensory impairments and specific learning disabilities. It is a huge common misconception that the mere presence of a sensory impairment automatically rules out specific learning disability such as dyslexia. A sensory impairment may contribute to academic challenges but it may not be the primary cause of underachievement. So when you're looking at these kids, you need to consider what is a primary factor and what is a contributing factor. You may have the -- you may have a child who has coexisting disabilities and it's important that these are recognized in the student. But also it's important to keep in mind that the identification of a coexisting disability is not a prerequisite for a student to receive appropriate academic interventions and support. A child who is eligible for special education should receive any appropriate support that will enable them to make progress in the general education curriculum. This is a really powerful two-page handout. The first page of it is shown on the right side of the screen. It's like a Q&A-style document. There are easy to approach with, you know, an ARD committee or during a staffing, if needed. So that was my recommended six-step approach. So step 1, reviewing the regulations and guidance. Step 2, establishing that multidisciplinary team. Step 3, reviewing records, interviewing, observing. Step 4, planning assessments to ensure accessibility -- or planning assessments and then ensuring the accessibility of the assessments. Finally, step 5, that testing step. And then step 6, that multidisciplinary team data analysis. These are sources, references. Thank you, guys so much for taking the time to join me today. I hope that these strategies and insights help you. I hope they have empowered you and you're able to approach assessment more confidently. I hope that, you know, if you caught nothing here today, please know these references because there's a wealth of information that's out there just referring to the law, referring to making evaluation meaningful. Referring to the webinar handout that I had mentioned. Plethora of information. So together we can ensure that each student's unique strengths are recognized and supported. I want you guys to feel free to reach out with any questions and I hope that we can all continue to highlight the potential in all students.