^M00:00:01>> [ Music ] ^M00:00:15>> Chirs Tabb: Thank you again for attending today's presentation using the 2013 Michigan severity scales for orientation and mobility. Today's presentation is presented by Ruth Ann Marsh and Chris Tabb from Outreach Programs at Texas School for the Blind and Visually impaired. >>And we'll go ahead and jump into the scales here, and just as a note on the left-hand side of your screen there is a document pod. If you have not had an opportunity to download the documents for the severity scales and the sample student, they're available there. And on the right-hand side of the screen, you have the captioner running the captions; and there's a chat window on the far right, which some of you -- thank you for kindly letting us know that you couldn't hear us -- and that is where you can submit questions and you might get a typed response or something that we presented to the group through the phone connection. And we're going to go ahead and jump in here. ^M00:01:17>>The 2012 and 2013 sales were both available. Presently, on the Texas school for the Blind and Visually Impaired website we have the 2012 version and we are working on getting the 2013 version onto the website, but the the entire site in a state of revision, so it may take a bit. Basically the difference between the two years are that, in the 2013 version, the instructions were broken out into two different sets; so that there's one set, or packet for the basic scale, and one set, or packet, for the set that has additional needs for students. And the scale components have remained consistent between the two years. ^M00:02:00So what are these severity scales intended for? The scales are meant as a tool for determining the type and amount of service for individual students. It's not intended to be an assessment tool or an evaluation tool. It's for determining how much service to provide. They are a compilation of results of your students and can be used today caseload analysis with the addition of information from other areas, when you consider your travel time, the ARD preparation time -- all of those things that make up your day and week, with your caseload. And so, by using the tools, it can help to relay that information to an administrator, to your supervisor, to the rest of the team, for them to understand how all the components fit together for your caseload. So, how are the scales a different, and in this case we're not talking about the two different years, but we're talking about the basic version and the Plus version for those students with additional disabilities. So the basic scale is for students whose primary challenge is blindness and visual impairment related, only. And the Plus scale is for students whose visual impairment is also including additional disabilities that impact instruction. So it has to do with readiness for instruction; in addition to their vision loss and other disabilities. >> Use of these a scales provides a valid measure of need that is presented in an unbiased form. So the idea is, that if you as an O&M specialist, or any other O&M specialist, were to fill out the form for a student, you would come out with the same result; and so that inter-rater reliability is present in this -- there is certainly room for adjustment, and so slight variations can occur, but the idea would be that anyone who filled out that form for a particular student would have the same result, so that it can create an equitable situation. It allows other team members to understand the need for instruction, and at which levels, so that if you're working with a teacher, and the teacher is having difficulty understanding why it is that you need to pull their student for a certain number of hours per month; this is a way to help them understand why you would be using this time for the student, rather than having them be involved in another activity. And for the most part, when we go through the scale, you'll be able to see from the categories, that anyone -- any member of the team, whether they have professional training or not, could place a student at certain levels on the scale. Your professional judgment comes in when we make certain accommodations or adjustments, as well as, thinking how the service will be delivered. It also becomes documentation of considerations used to determine your service recommendation. And when you're meeting with your team in an ARD meeting, and you're asked how did you come to the decision to provide a certain amount of service for a student, this is a wonderful way to be able to share the information with your team. And it allows everyone to be able to, literally, be on the same page to understand how those determinations were made. The use of the scales allows for equitable service levels across all COMS in an area. We want to make sure that the student, who's in one particular school, is going to get the same something as another student, who is in the same grade, with a similar condition in another school; rather than having it be different between O&M instructors, or between schools. And apply the same scale to all students, on a providers whole caseload to standardize service recommendations. It is very important to note that, these scales are not intended to provide a way for you to fit in what you can, into your caseload time; it's really to provide, or indicate what the student needs. So as they go through these scales, they have a dual purpose of helping identify appropriate service levels for students, but also to help you to demonstrate to an administrator, to the supervisor, why you may, possibly, need additional staff to be able to provide adequate service. So, if we make an attempt to squeeze the student into a box, just to fit into that half an hour we have left in our schedule, we're not really giving that student what they need. And we're also not demonstrating the need for additional staff to provide that service. So, keeping in mind that as we go through these, it's really intended to give the students what they need; not what we are able to provide with our current resources, but just an indication of what the student needs in order to benefit from education. ^M00:06:52>> So, we're going to go through some category definitions, and if you have your document with you, that will help. There are rows and columns, and on this grid for the scales, we have two different parts of the vision. We have medical and functional. And just as you know, if you visited the eye doctor with your student, it can be very different, what happens in a clinical setting compared to what you observe with that student when you're traveling through the environment. The medical is divided into two portions. There's distance acuity, as well as the peripheral field. And there will be -- when we get to that portion -- two scores for that particular area, if that student has residual vision -- we'll be looking at both their field, as well as the acuity; if the student has no light perception, then we'll only be receiving one score, because at that point the field is not an option. If a student, for instance, has an acuity loss and has visual acuities of 2,400, but they also have scotomas, that can create a dual challenge for the student, and that is why we would have two scores in that area. Their level of functional vision is how they're going to use that vision in residential, indoor, different types of environments; and again this is where your observation and judgment as a professional is allowing you to determine, is this student functioning at a level that's appropriate for the level of the vision loss they have; do they need additional training on how to use their vision. And so, we'll get into some of those details as we go through a sample student through the scales. ^M00:08:42>> The important note here on the category definition is, for students who have mastered age or developmentally appropriate travel skills; such as cane travel, echolocation; you're going to score them at a zero. Not to say that they don't have a challenge, but this is -- if the visual impairment impacts the ability to use vision for travel skills will be a zero, if there are the functioning at a level that is appropriate. So, we need to keep in mind that if somehow a student who has no educational needs, who is already a perfect traveler, isn't having challenges; they're going to receive a zero or very low score, because that need for instruction isn't present. And it might be that as an elementary school student, they have sufficient skills, but by the time they get to middle school, they need to be crossing streets independently -- which we wouldn't necessarily have an elementary student doing -- that score might change. So this is a tool that you can again and again, depending on the student's level of travel at each educational stage or phase. ^M00:09:49>> Going onto further categories. The use and proficiency of the travel tool. For some students it will be an adaptive mobility device. For some students that might be a power chair combined with their long cane, and so it's going to vary from student to student and their own individual needs. The discrepancy in travel skills between present and projected levels; if you as a professional, feel that this student is able to do much more, they just need to be able to develop some basic skills in order to do that; that's where we're going to be having that discrepancy between their potential and where they're functioning at the present time. Independence in travel for the current and familiar environments. And again, if this is just something that they're doing every day, heading from their classroom to the cafeteria, from their classroom to the restroom or their locker; that's going to be something that's current and familiar. As opposed to something that's putting them in an area that they haven't ever been in before. The spatial, environmental conceptual understanding; that's something that, certainly, depending on how long the student has had their visual impairment, could be significant. If a student is newly, visually impaired, they may still be getting used to their spatial awareness as a non-visual traveler. And that's something that will have to be reevaluated as they move forward and develop skills and abilities; as well as their conceptual understanding. ^M00:11:20Complexity or introduction of new environment. This could be that they just moved to a new home area. It could be that they're transitioning from a middle school to a high school; beginning to take extra classes or activities outside the school, such as some job-related training. The next category definition, opportunities for use of skills outside of school. Is that something they, with their academic demands, they're going to have an opportunity to practice? Is that something the family will be able to facilitate? A student who is able to have a lot of practice using public transportation will have a different level of need than a student who only has an opportunity to practice public transportation once every quarter. Then we're going to move into contributing factors. So the category definitions are the beginning coding part, where we are going to give a score from 0 to 4 for each area. Contributing factors are based on a slight adjustment to that initial score; where we will be either adding, or taking away, half a point; and this is where your professional judgment helps to balance out the student. Sometimes what's reflected on the front of the page, isn't showing the complete picture of the student; and by using the contributing factors we help to further refine what's unique about this individual student and their needs. So, each factor, again is marked with half a point; and it may seem like not very much, to add a half a point, but by the time you go through all the factors, we're at a level of 7 to 8 points; which will create a shift that, if all 7 or 8 points were there, could switch a student from being seen on a monthly basis to being seen on a weekly basis. So, using these adjusting, or contributing, factors can make a significant difference in the level of service that a student receives. Contributing factors continuing; we have their posture, gait and motor development; other physical or health impairments; the nature of the disease or condition -- again if it's going to be a condition that's stable, we are not going to be making an adjustment, but if the prognosis is for deterioration, that' s something that we may need to take into consideration, to increase the amount of service; so that, as that student's progression continues, we're able to meet the need for that student, as their vision is changing. ^M00:13:56The nature of the eye disease or condition; transition to a new school, neighborhood, work site; the age of onset of the visual impairment; maturity and motivation; the team's committment for follow-up; travel time needed to transport a student to an area of instruction -- affecting frequency of instruction -- and this is an area -- this is a side note -- has been discussed, that possibly, Texas needs to have its own scales; such as the VISSIT scale which is used for teachers of the visually impaired. And at some point, it's possible that Texas may look into developing its own scale, so we can consider which areas are important to have as contributing factors. So, in continuing with our list here; instructions with low vision aids; instruction in the use of the GPS; and an area that's open for you to be able to explain in the 'other.' ^M00:14:58After all these points have been tallied, from the front page and then with the adjustments made for adding or subtracting; you're going to have a point total. And that point total will range from zero up to 36, and you're going to be putting that into one of 4 levels of service -- excuse me, one of 6 levels of service, or brackets of service; and that will be something that you'll use as a guideline, to be able to indicate how much service you'll be able to provide to that student. There's a great deal of variation in even a student who gets, let's say, 60 minutes a week; how that service is delivered. For some students, 60 minutes all at once would be too much. And so we might look at -- although it is 60 minutes; dividing that 60 minutes into three small sessions to allow for that particular student's endurance for instruction; whether it's physical endurance, emotional endurance... If it's that the team needs facilitation for making transitions on campus, different types of activities. So, we'll look at some of those ways of fine-tuning the recommendation to the amount of services as we move to the sample student, but this is an area of professional judgment where you'll be able to exercise what you feel is best for that student, to be able to make that recommendation. S,o the scales are not intended to give you a hard and fast rule of student A must receive 60 minutes per week. It's more of a guideline to facilitate having an equitable amount of service between all students on a caseload; all students in a service area; as well as helping to guide professionals in finding a service level, when they initially receive a student; although they may not have much experience with that student. Recommendations of service. The six brackets are going to be broken into: Service Not Indicated, so this is where a very proficient student, for their particular age level; it might be that no services are needed at the present time, and that's why we would have Services Not Indicated. They may still qualify for orientation mobility services, but it might be that this is only on a consult level, at the present time, for various reasons; which could be just that they are very proficient travelers at their age appropriate level. The next bracket would be One to Five Times per Year; and this, again, could be a consult; it could be that the student does very well taking information and applying it on their on, and when they meet with the O&M instructor, they're receiving new skills and then they're able to practice that, outside of school hours on their own. ^M00:17:55Three to Four Times per Semester. One to Two Times per Month. One to Two Times per Week, I know for some of you, one to two times per week could seem like an incredible amount. If you're itinerant, and in a large service area, again it's important to remember we're not intending to indicate what fits in our own caseload levels. We're really indicating what the student's needs are. And trying to think in terms of, if you receive this student from another district, would you want that student, within their IEP, on the schedule of services, to have what fit into that previous instructor's plan or what that student really needed? Once you know what the student needs, then you can work with your supervisors, your administrators, to be able to have the level of personnel to be able provide that related service for the students at that level. And going on from there... ^M00:18:55So we are scrolling down through the document until we get to the severity of needs scale, the basic scale. And we're just going to take a sample student; and while we are scrolling, I'm just going to give you a little bit of information on the hypothetical student. I attempted to find a student who would have... the need for both types of... vision in the medical category needing a score, as often happens. So, if you would, consider that this student has an acuity loss, as well as having... some scotomas which would reduces their level of the vision. This would be a student, who is, an academic student in high school, 11th grade, preparing to -- at some point in the near future, transition to a four-year college. And so we have a student who is newly visually impaired, with significant challenges adjusting to that vision, but who definitely needs to have orientation and mobility services. And so we're going to go through this together. We have Jane Doe... and she's an 11th grader, an academic student and we look at the -- just kinda describe what we have in our chart here -- the columns that we have are going to be numbered zero through 4, with zero being none, 1 being mild, 2 being moderate, 3 is severe, and 4 is profound. When we get to the plus scale we're going to look at things from a little bit different perspective, but for right now we are going to go through the basics. The rows that will be on our -- the titles of which -- the category definitions on the left-hand side, will give us our area that we are considering as we move across the chart. So number one, the Level of Vision for medical is broken into two parts, again, where we have distance acuity and peripheral field. So for this student, what we're going to do is, if you have your sample, you can use that as a reference. If not, you can just kinda follow along. This student we scored because, they had a level of vision at 2,400, they're in the moderate range. And that's going to be a 2. So we just place a 2 to it to the top part, if possible. I'm not sure how this is going to work on the screen. >> Kate Hurst: Can you see what I've done... >> Tabb: I can see that you've highlighted that, and I'm going to ask [inaudible] if she can, with her magic mouse, there, place a 2 in the top part of that score. We're just going to combine our own, in the peripheral field area, we have... a field loss -- excuse me, the second category of vision, the functional, again we have the -- none through profound. Because this particular student -- it's affecting their visual impairment in all areas, or all environments, we're going to use the number 4 for the score. And you can see as you -- as Kate is circling for us there -- we have 2, 2 and 4. And for number 3, we're thinking about the proficiency of the travel tool, the cane. ^M00:22:38And at this point, we're introducing that tool, so the student does not have the level of skill with the tool that a student that's been using it for their full educational career would have; although they might be a very quick learner. So we're going to use the severe category; and as we're going through, we're just adding those numbers together. The next row, which is our Discrepancy and Travel Skills between the Present and Projected Levels; none would be no discrepancy, so on and so forth -- moving through -- the profound level would be discrepancy in all situations, and because the student may have had some ability to use certain areas, this is going to be a most. And again, as the team observes, it might be that you're working collaboratively with the teacher, or some other related service professionals, to be able to inquire with them, "How is the student doing between classes?" Or asking the parent, "How is the student doing finding their to a friends house in a residential area?" It may not be that you've had the opportunity to work with the student during their first ARD, to the level you would like to be able to do, in order to develop a schedule of service for them; and this is a great tool to be able to use collaboratively. So the fifth area, independence in their current and familiar environments. Again, you can observe them traveling at school. You can observe them if they have an internship traveling to their job. Below number six, we have Spatial, Environmental Conceptual Understanding. And as you go through you'll see the different areas here, that they're sufficient for their development of travel skills; all the way to the profound level, where it's profound inhibiting the conceptual understanding. So, we need to consider that student's conceptual level with their visual impairment in mind; that's where you're going to use the area for number six. Number seven, the Complexity or Introduction of New Environments. If, again, this is a student who is going to be attending a junior college or a four-year institution, there is going to be a significant need for them to prepare to transition to, maybe a large open campus with intersecting pathways, that wouldn't be, necessarily, as defined as their high school. And number eight, Opportunities for Use of Skills Outside of School. If this is a student who is on all AP classes and their parent is quite concerned about them being pulled from certain activities, or making sure that they have time to spend within their school environment; extracurricular activities that they're involved in -- the debate team, a sports team -- that might limit the amount of time that they have to practice these skills for reinforcement or additional development outside of school time. So we're going to provide the profound level there. And going onto the following page -- and we're going to get in, now, to our contributing factors. So each of these areas with the posture and the gait, motor development, so on and so forth, for the contributing factors -- going through for student example, with a recent vision loss, we would be adding half a point... for potential for improvement; another half a point. The age of onset of the visual impairment, because it is a new condition for this student; adding half a point. Their maturity and motivation; adding a half a point. The instruction and use of the GPS, adding half a point. And so our score would go from being a 28, and adding two and a half points, to 30 1/2 points. ^M00:26:47I'm going to use a side example. There are some students who have very little residual vision, and travel as though they have more vision than they actually present with. As an example, they may think they're seeing just fine, and they travel down the sidewalk, not realizing there is a fence, because their vision is not showing them the fence. Their vision goes right to the holes in the hurricane fence, and they think they can perceive, because their vision is telling them they can. In that particular situation, the vision is causing them more challenge than if they were traveling without any vision. And so, there are times when it becomes -- though the vision can be helpful, they are using it in a way that is inhibiting them from being a safe traveler. And so, they may need to learn how to use their vision, what level of trusting the vision is safe, whether the student who is totally visually impaired, or is traveling under a blindfold, would only be relying on non-visual skills, and may travel differently. So, I wasn't part of the writing process, but I believe that those are the situations where a student who is trying to balance between having vision, though it may not be enough for them to travel safely; and not having vision, where that score could vary. When we talk about a student receiving a score of a zero, because they're using vision, or their lack of vision appropriately; that's something that we need to consider. If the student is fully adjusted to visual impairment or total blindness, then they're going to be receiving that zero, because it's not affecting their ability to travel. There are some students who are very comfortable using echolocation, there are some students who are very comfortable using different sensory inputs; they're using their kinesthetic, haptic, their proprioceptive -- all different inputs together; and they're going to demonstrate less challenge in the environment than a student to is just learning what they can trust in their vision and what they can't. In other words, if they're using that keyhole of vision, and really struggling to do so, what other sensory inputs are they ignoring? So, that's something that you, as a professional, will have to determine, "How can I score this student?" So there are some gray areas in some points, that you as a professional, have to talk with the team; consider the different factors, this is just a guideline. ^M00:29:31So, we gotten our score of 30 and 1/2, and we'll just call this the adjusted score, because we have gone in with the contributing factors; we've made those adjustments based on that student's particular, unique conditions. Just as an example, of taking away points. It might be that the student is very rarely on campus, because they have a big medical condition; that might be something that would have an impact on how often we see them. Again, our service is just one service within that student's entire school career, and we have to balance all members of the team and what's most appropriate for that student. ^M00:30:13And before we jump to the next one -- Oops, sorry >> Hurst: [ off-camera ] I thought that would be better. >> Tabb: So, on the right-hand side, and hopefully the bold arrows that go on this page, that kind of point from the final severity of need score, which is the adjusted score, and then that long arrow, going from the bottom of the page toward the top of the page; which brings us over to the frequency of service. It's kind of guiding you through the grid so that you'll know how it flows. So, we go from the contributing factors to the final score, up to the severity of needs score with frequency of service determined. So this student's number, their score, is 30 and 1/2 25; and from that 30 and 1/2, it puts us in the highest bracket of service. 25 to 36 points is basically where this will lands. That's a pretty big spread, because we can have students with significant differences in the amount of need that they have, within that set of points. >> We have 11 points there that's a change, just with that one bracket. So, we have some students who might need to have -- if you think about two or more times a week. Well, that could three times a week, at 60 minutes each; or up to 180 minutes. Other students might just need two 30 minute lessons. So depending on the age, the maturity, the endurance of that student, we can craft, what we feel is an appropriate level of service. Below that box, we have a recommendation of service. And so, we put in the amount of service, and in this particular instance, we said 2 times per week for 50 minutes. When this student's initially seen, it might be that we're just trying to teach them how to use their cane; and work with them on some basic skills for navigation and protective techniques. Whereas, once they develop these skills, we might be working on public transportation and need to be in the community for longer than a 50 minute period. And so, we might choose, at that point, to combine those. So we're meeting for both of those 50 minute lessons, back-to-back. ^M00:32:28We're not supposed to take a student for more than we've indicated in the ARD, because, though a parent might be very happy about it, in theory you're pulling them from some other activity. And some parents and team members might be concerned about, "Well, that's great you're able to see them more, but what are you taking them out of?" So it's important that when we develop that level of service, we've documented it. It is possible, within the ARD document, whether you're using ESPED, or any other type of system, to be able to define how you're going to provide that service. And you can have different types of service, at the beginning of the year compared to the end of the year; but basically, this is just another area where you can use your professional judgment, in order to demonstrate what that student needs. And we're going to go ahead now I'll move into the -- we have a couple of slides about the severity scale with a plus. So we will go back to the PowerPoint presentation momentarily. ^M00:33:28>> And on the plus scale, in some ways takes us in an opposite approach. So, the level of profoundness is going to have a different impact. So, certainly a profound vision loss is going to warrant more service, but profound challenges in other areas, such as behavior, might make it difficult to be ready to receive instruction. And so, that would remove points, so to speak, for that student's final score for receiving instruction. Now, the team is going to be working together to make sure that a behavior intervention plan is in place, or that positive support interactions are there to be able to help this student move along a continuum, to be able to be at a place where they're ready for instruction. Some of the category definitions are different, and so we're going to go through those as well. Communication -- so, again, on the main grid where we had zero through 4 for our column; and we had the eight different categories along the left-hand side. When we use the plus presentation four of the other categories are going to change. We are now going to have a category definition for Communication, Non-Visual Additional Needs, Level of Supervision Needed, Spatial Environmental Concepts, and Compliance with Instruction. So the Spatial Environmental Concept is listed in both, but the way we perceive them is a little bit different. And, Kate, if we're able to bring up the other grid -- and while that's refreshing, I'm going to go through and talk a little bit about the first one. ^M00:35:12We still have the level of vision, with a medical definition as well as a functional definition. We still have the Level of Proficiency with a Travel Tool. The new column that we have -- excuse me, the new row that we have, is Communication. In the... the beginning column of None, the zero point, the level of communication prevents the ability to benefit from instruction. So, if we have a student who is still learning communication skills, and may not even be using tactile sign or a communication box with tactile symbols, and we're really at a level where that student is just beginning to understand that interaction; that's going to be taking away from their ability to have that present need or readiness for instruction. On the opposite end of the spectrum, for that same row, is a profound level where the communication is sufficient for the student to benefit from instruction. So it's not that the student has a profound communication challenge, it's that now we have that student with a profound need for instruction, because of their readiness to use communication to be able to benefit from instruction. So again, we're switching how we're perceiving what profound is in some areas. ^M00:36:40Non-Visual Additional Needs. In our none category, we have Non-Visual Additional Needs profoundly impact the students -- impacting the success in O&M. So if we have a student who has the need for an aid to be with them for medical needs, under all circumstances; who has breathing equipment, feeding equipment; we can start compiling more and more things; adding to that list of things that would make it challenging for that student to benefit or receive instruction. And then, bring ourselves over to the profound level again. It's the Non-Visual Additional Needs have no impact on the success of O&M. Of course we also have the mild, the moderate and the severe levels. The level of supervision in row number 6, is that the needs for total assistance are, therefore, safe travel -- so if we do not expect this student to every be traveling independently, under any circumstances, that's going to be at that none level; which would basically take away from the students present level of need. These can certainly change, from time to time, if the student is demonstrating increased ability to be able to be independent in different environments. Even if it's just in the school environment. That number might move from being a zero, increasing up to, for instance, that the student need close supervision and physical prompting; or that that student needs verbal prompting; or that they need close supervision; it maybe be from a distance, and that might be something where the teacher is observing a student travel from the classroom down to the restroom. They still need to be supervised, so it can be the teacher monitoring from a distance, but we would still be working with that student for their independent travel; because they would still be making a choice on their own; when to go forward, when to make their turns, so on and so forth. And that would increase their need and readiness for instruction. Spatial/Environmental Conceptual Understanding is going to be at the range with the none level being, progress in O&M is profoundly inhibited by the conceptual understanding; and just as a comparison between the basic scale, when we the none or spatial environmental conceptual understanding, the none, in basic form, without the additional needs, is that conceptual understanding is sufficient. So again, we have changed those two areas and how we perceive what would be the none category for their spatial understanding. ^M00:39:33Compliance with Instruction. Which is row number 8. We have none or zero for their score, would be noncompliant with instruction, and certainly at the profound level, with a profound readiness or need for instruction would be cooperative and compliant. And so, that would bring us -- adding the numbers just as we did in the first form, onto the next page, which would be our contributing factors. The contributing factors have many similarities, but by the same token, we do have some things that have changed between the two. There certainly additional areas for the O&M instructor to add an 'other' or to explain; and we have students with additional needs to have diverse challenges; and this is an area where it would allow you to add those challenges, to be able to define who that student is, as a person at the present time, using the scale. It may be that that changes from year to year or from teacher to teacher. It may be that with one particular aid, they function in one way, and halfway through the school year they received another aid, and the level of support is different, or the level of trust between the two is different, and an adjustment may have to be made here. And, working with your team to make sure that those adjustments are reflected, is helpful; and making sure that the student has the appropriate amount of instruction and scheduled service. >> Hurst: Chris, I have a question, would this be the place where, for example, if a child were also hearing-impaired, that I would use the other slot and and indicate that there was a hearing loss, and therefore, maybe requiring additional services or additional support, or something. That would the place I could put it? >> You could certainly put that. There is the possibility that the student would be on a basic scale with the hearing loss, as well. And because we did have an other category there as well, that particular scale, for the basic scale, would be a student that we would think of as maybe a more academic student, who's functioning at an age appropriate level for the most part. The student who has, perhaps, a cognitive impairment, along with a hearing loss, as well as a vision loss -- it's a student who we would normally be representing here, and we could 'corrected hearing loss' or the use of aids, such as the behind the ear aid, or cochlear implant -- learning to use that. >> Ruth Ann Marsh: And that's why the first decision you have to make is which scale you're going to use for the student. And if you aren't sure, you actually fill out both scales and then see what the comparison between the two scales are; which one do you think is more appropriate for the professional judgement that you would make? ^M00:42:28 >> Just as a quick recap, the scales are not intended to be an evaluation for the student or an assessment. They are intended to help determine what's an appropriate amount of service; and by using the same tool with all the students in your case load, and within the district or region, allows all students in that area, regardless of instructor, to be able to receive equitable service, so that it wouldn't occur that a student who was at one elementary school would be receiving one hour, and a student with the same level of functioning and vision, at another elementary school, might only be receiving an hour a month. So this allows everyone to be receiving a fair and adequate level of service, and also helps you to document the possible discrepancy between the level of service that you can provide, within a 24-hour day, and what's actually there. So if you need the additional personnel, this is a way to document why you need to have another O&M person to facilitate that; or perhaps bringing on a contract person. It may be that last year, you were able to meet the needs of the students, but this year, the mix of your case load is such that you have students who have a greater need and require more service. And it may be that you need to request having someone as a half-time, contract person come in during this particular school year to help meet the need. And we're going to go ahead and move forward a little bit here; and I think it might be that we are into -- that's the last slide. >> Hurst: We have time for questions. >> Tabb: We have time for questions if anyone has a question. >> Hurst: What have you all been putting under field? I have never seen a degree marked within the field test on my report. Usually that section is blank or marked unable. >> Tabb: Generally speaking that's an area that... a low vision report, functional vision evaluation should be covered on the state exam -- the form for the state exam does include that -- it's another reason it's very helpful, as an Orientation and Mobility Specialist, if you're able to attend the eye exam with the student; or at least speak with the professional, before they do the exam, to encourage them to attempt to evaluate the field. It is very helpful. There are different techniques that they can use to evaluate the field. The low vision provider sometimes has a few more options, in that they might have some strategies for working with young children; who would be less likely to indicate when they see the dot; on the right, or the left. They can use different toys. They can use, what's called a confrontation; basically having different things from different areas, coming in and measuring. They can use electronic equipment. There are many different avenues that vision doctors have today to be able to assess and evaluate that field. If you know, from your own experience, that a student is missing certain areas, if they're missing drop-offs, it they're missing head-level obstacles; that's an area that you could also begin to consider, if there were a field loss in that particular area. >> Hurst: Chris, I have a question. Wouldn't information like that also be, conceivably, in the functional vision evaluation and that so, the notion of collaborating with that TVI; you've got any concerns, or if that's information you feel like you typically need? >> Tabb: Yes, that's certainly in the functional vision. That should be there, to talk about how that -- the vision is utilized by the student, and any particular strengths or challenges they have with their vision, definitely. >> Marsh: It's a really good reason for the O&M specialist and the TVI to collaborate when they do, at least, part of the functional vision, because it's very difficult to test fields, when it's just one person. It works much better with two people. >> Yes, I could see how that could work, especially if they are quite young -- that really gets tricky. Good question. >> Thank you for the question. Thank you for being here today and listening and for your patience. ^M00:47:03 [ Music ]