TRANSCRIPT Ð Ensuring Meaningful Access for Students with CVI Ð 02-07-21

>>Stephanie: Today we're going to discuss Ensuring Meaningful Access for Students with CVI. I'm Stephanie Steffer, I'm the business director with CVI Connect and one of the founding teachers of the platform. Before this role I was a teacher consultant for children with visual impairment for ten years. And I primarily work with students who had CVI and worked a lot with children with severe multiple impairments, especially with the birth to three population. In Michigan we serve kids from birth to 26 but I also had my early childhood endorsement so a lot of my time was spent early on with kiddos birth to three but I also worked with students up to age 26 on occasion as well. I had a good variety on my case load, typically. And so, we've already talked about where everyone's from but as we continue through, please feel free to drop in the chat what your role is as a learner with CVI, whether you're a family member, teacher, consultant, or a teacher for the visually impaired, OT, PT. We have a lot of people who care a lot for these kids and it helps me then understand what kind of we're talking to as we move forward. Lots of TVIs and O&M. SLP. Awesome, parent. Welcome. Like I said, I'm coming from the background from the TVI stance and so that's where my mindset is a lot and I'm going to try to make sure I cover a variety of areas so as we're going through this I'm meeting the needs of the parents as well as the SLP and so forth so that everyone is getting what they need out of today's session. But feel free to drop questions in the chat or if there's something specific you want to talk about from your perspective I'll do my best to answer but I can't really get into specific instances just because I don't know your learner but we'll do the best that we can. This is the objectives that you see on your screen now are actually for -- this is part one and there's also a part two session and so we'll cover all of these throughout the remainder of today's session and the follow-up session as well. In order for us to understand how to ensure access for students with CVI, we have to understand what our role is in education. And I found this excerpt -- I have a picture here with a few notes on it. But we're actually going to open up this document so I can show you what this looks like. Kaycee can you confirm you are looking at the U.S. Department document? And she just posted the link as well, thank you, Kaycee for that. So, the document that's in here is referring to understanding the eligibility of a child with a visual impairment. This was written in 2017 but I feel like families and educators that understand cortical visual impairment or still fighting this good fight on a regular basis and it's understanding that need. If you want, I highly encourage everyone to take a closer look at this document when you get a chance but it really references the most important things we need to look at as far as visual impairment. And we're looking for that adverse effect to the child's educational performance. And in order to do that, we need to look at a few things and so the first thing we have to do is the eligibility team needs to consider whether the child has one or more conditions and we're looking at the field loss. And this also includes diagnosed with cortical visual impairment, degenerative condition, not uncommon for us to know about in the field. This part, the condition adversely affects the child's educational performance. That's so key for what we're doing. So, when you get this note -- for some reason it's not scrolling right for me. I apologize. When you do this, once you have done your functional vision assessment to prove that adverse impact, you're thinking about its impact on the child's ability to learn to read, write, do mathematical calculations and use computers or other technology as well as the child's ability to be involved in and make progress in the general ed curriculum offered to non-disabled students. If their vision is in direct relationship to any of this progress that's going to result in them needing services that can help provide access to this education to this curriculum. So, knowing that that is our goal -- so we've identified that we're going to need to help these students, that's who we're looking at. This is the group we're looking at. I thought it was really important that we cover understanding what the federal law says and understanding what our role is as educators -- and we're going to continue coming back to this throughout the presentation. Another thing before we get too deep that is really important is we look at this cerebral versus cortical. I have excerpts from Dr. Roman's book that cerebral is considered encompasses all forms of visual processing disorders including those that have been associated with visual perceptual difficulties whereas cortical affects the posterior visual system. Both of these quotes are taken directly from her text and I think the reason I really want to go through this is that I'm looking specifically at the cortical visual diagnosis. I have done a lot of sessions with both those who focus their research on cerebral and those who have focused their research on cortical and the students that I see or have seen as a teacher for the visually impaired had cortical visual impairment. I have not come across students with cerebral visual impairment so I don't feel like I can talk to the need that encompasses all of those visual processing orders like I can with those who have cortical visual impairment. When I speak to that I'm speaking of the three elements that Dr. Roman has identified to identify children with cortical visual impairment. And so, the first she says is an eye exam that does not explain the individual's functional use of vision. The second is the history of a brain condition, trauma, or damage associated with CVI. And the last is the presence of a certain visual and behavioral characteristic, which we know to be those ten characteristics that she identifies. You might hear me talk about things like color, latency, et cetera. Those are the three things you're looking for in order to identify an individual with CVI. Today we will focus on these accommodations to provide access for our students and this quote here is also from Dr. Roman's 2018 text. And it says the work of those who teach children with CVI is to systematically provide adaptations and specifically design instruction that will develop and broaden the child's representations. I felt like this quote just has so much important meaning just wrapped in this one little bit. You know, I've read it over and over. I've done lots of sessions where I had this quote incorporated and I just think that it hones in on what each of us on the IEP team are responsible for. So, it's not always just the TVI, it's not just the SLP, it's not the parent, it's all of us that need to come together and understand how you can specifically design instruction that will broaden these representations for the child so they understand and have access to the world around them. So, you're going to see this figure a lot. It's the data driven instruction wheel and I typically like to start at the collect data side here in this brown tab. It goes around to analyze data, make instructional decisions, plan, reflect, and repeat. And for me this is how you do things in education. This is how I've been drilled in my brain that data collection is the way to go and you have to provide data-driven instruction. In order for me to figure out where I'm going I have to figure out where I am and that's why I always start at the collect data standpoint. And so, I can figure out what that baseline is. So, for students with CVI as we mentioned in the IDEA policy from OSEP, the first thing we have to do is the functional vision evaluation. And for students with cortical visual impairment, I use the CVI range by Christina Roman Lansky. Which includes three parts. Not going to go into depth today on how to do the tool or use it because there are plenty of resources out there and I know the Coffee Hour has presented several things between Sarah and Lynne and having Dr. Roman on, so there's things out there. If this is new to you, definitely check those out and be sure to watch those because they're really helpful. Essentially what I want you guys to know is that when you completed the CVI range, you're going to get a score from the rating one assessment -- sorry, range one and range two. No. Rating one to rating two and you're going to use that to create your range. You'll get a score from 0 to 10 from both of those and that's going to be your CVI range score for your student. And the reason that's important is because that's going to tell us what phase the child is in. We're going to get to that in just a second. So now that we have had our initial collection of data, we have our rating one and rating two score. Now we can move into looking at these different aspects. And so, this is the rating two characteristic and Dr. Roman considers these within the CVI characteristics. And this list of characteristics from here where you're pulling this information is actually great to be used as your accommodation. The information that you're pulling from rating one is great to put in that present level of your IEP. Now that you know where you're at, now you know where you're going with those tools using those accommodations. From the CVI range we're able to place the child into the different phases, so we have Phase 1, 2, and 3. Each phase of CVI has a specific goal associated with it. So, children in Phase 1, or someone who has a range score of 0 to 3, is in Phase 1 and their goal is to build consistent visual behavior. And in Phase 2, somebody with a score of 3 plus to 7 or just under 7, there their goal is to integrate vision with function. Finally, anything above 7 to a hypothetical 10, which would be Phase 3. Here we're looking to refine those characteristics. Dr. Roman cautions us that children all along the CVI range are unique and even two children with the exact same score are going to have completely different needs. And it's difficult to cluster accommodations by phase and each student should be looked at individually. But in order to better understand what I mean, we're going to take a look at the characteristics as they relate generally to children in each of the phases. So here I have on the right an image of the CVI progress chart, which is available in Dr. Roman's second edition text. And in here she has different scoring criteria that she has implemented. I've highlighted the section for range scores of 1 to 2 and 3 to 4, which on a grading scale of 2 is a score of 0 and .25. Okay? So typically, this would fall within the Phase 1 realm of a score, right, which is building visual behavior. And the reason that I've done this is to look at what characteristics -- for each of the characteristics what we would be looking for that child. So, a child in Phase 1 would be typically attending to single or preferred colors. They might only be looking at objects that have movement. They're going to have a longer period of latency and using this tool in her textbook will give you those specific standards of what you're going to look for a child in Phase 1. That being said, you would have what we then would call the CVI overlay, or Judy Endicott calls the CVI overlay. I think not too long ago you guys had on a Coffee Hour. We take this information from that CVI range score and can build in the consistently opportunities throughout their day to build opportunities for them to use their vision. We're going to have a controlled environment and we might use things like a slinky or pompom or a beaded necklace. You have seen these examples and heard about them in many conferences and webinars. It is important to understand why you are using it and how you're using it. What is the intention for me to do this? And what is it going to do for the child later? Well, the important part is whatever that familiar object is or however you're pairing it with light while right now is being used for consistent visual behavior, in Phase 2 we're going to use that main feature to now build visual function. So, the things you use in Phase 1 should build off of one another to do -- to build in that next step into Phase 2. So, I would recommend typically that you start with identifying three times throughout the day and looking at how you can utilize these different types of interventions in your child's routine to use vision consistently throughout their day. So, this next slide has another quote from Dr. Roman. It says some students with CVI may seem to enjoy looking at scenes outside the window or a novel picture in books. But it is critical to recognize that looking at a target cannot be equated with interpreting what is seen. As we move from Phase 1 to 2, our learners move from solely using their dorsal stream vision and begin to use their ventral stream vision. If you have heard those terms or never understood them, dorsal is what we call our where vision. Students in Phase 1 are only using this dorsal stream vision to localize where their visual targets that we present are located. And our ventral stream vision is our what vision. In order to use our ventral stream vision, an individual must first have eye contact or joint attention. So, this was an example that was given to me -- I want to say it was done by Chris Russell but I could be wrong and it's been so long since I was at a session with him. This was before COVID. But if you have a piece of paper nearby, I'm going to go ahead and share my video. You can see me while I do this. But if you have a piece of paper nearby, anything that has writing on it, a book, or anything like that, set that in your peripheral field so you're not looking directly at it, you're still looking at your computer screen watching me or my slides. In your peripheral vision you have a note or something that has something written on it. Maybe you have a poster in your office or something like that next to you. You can see where that item is. I know I have a yellow note card in my peripheral field but I cannot see what is on it. I'm using my dorsal stream vision to know where that item is. In order for me to tell you what is written on this note card, I would need to make eye to object contact, which is accessing my ventral stream vision. So, when I bring that note card into my central vision and I'm looking directly at it I can read the notes I have written on that note card because I'm accessing my ventral stream vision. Thinking about that for a second, a lot of us have -- whether it was we're new to kids with CVI or felt pressure from the IEP team, whatever the case may be, I have seen it a lot. I know it did it early in my career. We have a student who is Phase 1 and we are presenting them with materials that are really the expectation is Phase 2. Because we see them looking in regarding to something. Like looking outside or flipping pages in a book. But that doesn't mean that they're really recognizing that target, number one. But if they're in Phase 1 they're also just knowing where something is, not making contact with it. It's really important as we bridge over from Phase 1 to 2 and from 2 to 3 that we know if they're actually using eye to object contact yet and if they are they actually identifying what's on there or are they just regarding that there is something in that vicinity and maybe not ready to identify that item just yet. So, there's a few different stages that our students will go through. Let's talk about Phase 2. I broke this into early Phase 2 and late Phase 2. And this is just purely through some conversations that I've had with Dr. Roman and there's just a very big difference to me between a child who is in early Phase 2 and a child who is in late Phase 2. Although the goal -- it's still one phase. This is isn't like Dr. Roman told me to separate this into early and late Phase 2. It's just Phase 2. That's the way we refer to it but I broke it into two different sections for you when I highlighted this chart, for a couple different reasons. So, a child in what I'm going to call early Phase 2 has like a score of .25 or a .5 on rating scale 2. So, again, I highlighted a couple of those characteristics for you to give you an idea of what things we'll be looking for. And then in late Phase 2 a child would be a score of, you know, .5 to .75-ish around rating scale 2. Remember, there can be an outlier but you should typically, in rating scale 2, see the scores clustered together. Okay. My fancy red cat there. Just for breaking things up in the slides a little bit. So, on the left we have the characteristics again listed for Phase 2. You're going to be using some of the similar items that you used that had characteristics from Phase 1. So, if they really were attentive to mylar items, you might use that mylar item again to attract their vision in Phase 2. They might now be able to view items that have more than one color and they might be still needed to have movement to really initiate that visual attention. I don't want to continue reading through this slide because you guys can read that on your own. And you'll have access to the PowerPoint as well. But a student in this stage is going to begin making that eye to object contact, which is really excellent. And then we got movement to initiate your visual attention. PowerPoint is amazing for stuff like this to have cool special effects and show you how you can do different things with technology. You'll see I have some random transitions to give you ideas of how you can use different characteristics in things like keynote and PowerPoint and other slide templates. But different topic so we'll keep focus here. Sorry. In that late Phase 2 you're really starting to identify the details and differentiate what the child is being seen and ensuring that the child is not just looking but interpreting. Do you remember, we talked about that just a second ago? And in order to build that interpretation we're going to require that the student gets direct instruction in order to understand what it is that they're using. So, as we integrate vision with function in Phase 2, it's important for us to remember that vision needs to precede the function. We need to encourage that they look first before reaching. For example, maybe activate a switch and you want to integrate your vision with that, you might cover the switch with something that was capturing their attention in Phase 1. Again, if it was mylar, maybe they had a mylar pompom they were attracted to in Phase 1, maybe now use that similar material over the top of the switch so you can get their attention to the switch first and then they would be able to hit it. And the theory being that if you use a familiar target the child will be able to utilize their vision first, then reach for that item that you're hoping for them to reach for. So, as we see learners move from early Phase 2 to late Phase 2 and then into Phase 3, we tend to look at the progression of images. And this is an example of how my brain processed this in this moment, so bear with me for a second. Matt presented this information at the pediatric cortical visual impairment conference in I think 2017 -- but I could be wrong. But this was a picture from his slide that when he was presenting. And it goes from the real object, the photograph to the illustration to the black and white item. And he talks about how when you're removing different characteristics how much more difficult it is for our learners to identify the item. Having the real object gives you color and visual texture and actual size and context clues. And so, with all of that it helps you figure out what the item is that you're looking at. When you're looking at the photo, you no longer have the actual size or context clues. When you have an illustration, now you've lost your cues and your visual texture. Black and white you only have salient features. You hear Dr. Roman talking about that and how it is so important. It is explained that this would be an ideal way for us to teach our learners with CVI and understanding what they understand and what do they see. He has an amazing webinar that's available on Perkins e-learning and I can add that link later in the chat if you guys would like. But it's really great on asking that question of what do you see and understanding how students are viewing the world around them. It will actually give you a good interpretation of how they're using their vision. But when he originally presented this, my mind went to, okay, so if I want to teach a student something, I'm going to have to go from their real toy that they're used to, that red cat, and then another example of a red cat and I'm going to have to outline the images of a realistic -- or highlight the salient features of the cat. Oh my goodness, look at this chart I created in my head of what all I have to do in order to get a child to learn the word "cat" and go down to literacy. I was thinking about all this information and from Dr. Roman's text and Matt T's assessment, I thought this was insane. Then I started to realize that pictures of items and words, you don't have to know a picture of an item in order to be able to read the text. In fact, the text is consistent. The word "cat" is not changing. It's very static. Even with different fonts, it's going to look pretty much the same. Every once in a while, you get the different A look to it where the curvy-looking A, like in the word "meaningful" has the A that looks funny. But if you use the same font, that word "cat" isn't going to change. Actually, teaching words to our student is actually a lot easier than teaching these images, right? And you don't have to have every image in the book ever imaginable in order for you to understand cat. I want you to understand the basic salient features of it so you can generalize that tone but I don't have to go through and teach every little thing. I want to teach what's meaningful for you now and continue on. Because there are so many images in our library, in our bank and I want to provide the student with the tools to problem solve moving forward more so than I do this entire bank of image library. And so, I want to teach them that even in this outlined drawing I can still see the triangle-shaped ears and I'm going to guess that this outline drawing was supposed to be a cat, even though it doesn't have the whiskers there. We're going to teach through into this moment instead of teaching this entire scaffolding of images and comparing it to other things. That's why the dog is in there. So, this is just my thought process. This is a slide of things. Don't try to sit down in one session and do everything above and beyond and kind of overwhelm yourself and your student. Let's take a step back and think about what's really most important for the child to have in that moment. What are you aiming for the child to learn? If the sight word is "cat," that's what you're working on. But if you're working on the word "cat" it's important to have the sounds, like the at. Maybe coloring it differently. If they have a stuffed animal cat, that's great, and compare it to an image with the highlighted salient features that you think is important but I don't think it's important to do the entire scaffolding here through all the images I have shown. Hopefully you can learn from my brain process and my mistakes in understanding things. The next one is for Phase 3 and I did the same thing where we have the CVI progress chart for Phase 3. And now for a child who is in Phase 3 on rating 2 we're going to be looking at the scoring criteria that Dr. Roman has outlined for .75 and a 1. So generally, within those scores. Now, please note that CVI is a lifelong condition and will always continue to impact the learner that has CVI. We're constantly coming across new things in our life and we have to use a lot of strategies in order to figure things out. I was just at a conference two weeks ago and the location that we were at was very overwhelming for me and just trying to navigate through things and figure out the signage and where my room was and where the conference rooms were and I just figured all of that out. There was a lot of people and noise and when all of those factors were adding to the processing of this new environment, imagine what that would be like for an individual with CVI. So even as a professional when they're going into new places that are unfamiliar to them or the first time they -- whatever it is that they do in their career, those things are going to definitely play a role in how they are able to continue forward. So, it's definitely about teaching compensatory skills for these things as well. So, at this point in time you may hear it's important for us to use color highlighting and that movement may not be required anymore and we can do pictures now and it's important for us to do comparative thought. But hearing all of that and understanding what it all means is a completely different story. And I just have an example really fast on the right where you can use color and movement to build fluency for readers. It just has a line that goes underneath the sentence. But it's kind of a quick overarch of what's important knowing that the environment, you know, you're going to need to use words to bring it up out of their lower field, that lower field might still be a difficult area for them. You might see some visual curiosity, depending on where the child's at and what the other environmental factors are looking like. I encourage in Phase 3 for you to consider a salient feature dictionary. There's a website, the CVI collaborative -- I can't remember the exact link -- but there is a link to I think Matt Tegan started it but you can add to it as well and it's just kind of a good starting point for salient teacher instruction but figure out what works best for your student and what's most meaningful for them. We're going to talk about salient features a little bit later but it's important to figure out what works best for your student in Phase 3 in figuring out how they need to -- what tools they need in order to be meaningful. Now you're thinking, great, Stephanie, I knew I needed to align it with my learner. Tell me more about how I do that. Here is that slide that we talked about with salient features. Salient features, thinking back to that cat, are how did I know the outlined image was a cat? It's because of those salient features that are prominent, like the triangle-shaped ears. In this case there's an elephant. Oh, here's that collaborative website, the salient feature collaborative feature website. I know it's an elephant because of the floppy ears and the trunk. The reason I put in here the how do you know question actually came from a -- I was at my daughter's gym class. The dad said watch out the elephant is going to get you. He said that's not an elephant, that's a giraffe. The son was actually coming up with different things about the elephant. Well, it's gray and it doesn't have a long neck. They were comparing the elephant and the giraffe and this is what we need to do for our kids with CVI as far as salient features and thought. We are talking about other features and comparing the other animals that they might be familiar with. And to do that we can use color to use what we call highlight or outline those salient features. Here we have the elephant's ear outlined and its trunk outlined. With an elephant you might even need to point out the different shape. The elephant's trunk is not always going to be like this. It might be moving, down, swinging or eating. Talk about how the elephant moves its trunk in order for the child to know it's not always going to be in this shape when they see an elephant. The elephant's trunk is moving around the ears might flap around but you're always going to see the ears and the trunk on an elephant. When we come to comparative thought for a child, we want to talk about things they're familiar with and things that are new to them and so in this case I like to think about the Venn diagram. If a child knew their toothbrush but needed to learn their spoon, maybe we would put -- start to think about what things are similar between the toothbrush and the spoon. So, they both have a long handle but the toothbrush has small bristles and the spoon has the curved scoop. When I make my Venn diagram, long handle becomes in the middle where they both have that similarity. So, then I might create an activity for the child where we either use the real item or use images to highlight and talk about those long handles on both of the items as well as then outlining the scoop and the small bristles and have that comparison conversation. So, this student was able to do two-dimensional tasks and so we were able to put it on to the tablet and have that conversation right on the iPad. But for others you might actually use the real item. So, this part of the presentation is something I absolutely love doing with everybody. So, we've talked about some of the characteristics for phases 1, 2, and 3. Hopefully that's nothing too new to you. But what I want to do is I want to talk about what -- whether an activity fits into Phase 1, 2, and 3 and really thinking about what we talked about earlier with the goals of each of those phases. What I'm going to do is I'm going to show you a sample activity, talk to you about what the purpose was of the activity, and then you're going to type in the chat and let me know if you think it belongs in Phase 1, 2, or 3 and then we'll have a little bit of conversation about it. Hopefully you guys don't mind playing along with me in the chat here. This image was actually taken from the everyday CVI blog. And this mom posts a lot of great ideas. So, if you're looking for a resource for your parents to check out or if you're a parent yourself and want to check it out, feel free to look at her blog as she kind of talks about her story. But here is an image where she's feeding her daughter and she is demonstrating the use of a mylar bow stuck to the end of the spoon and encouraging the visual attention during mealtime. So, she has the specific function that's associated with it. Do you think that would be Phase 1, 2, or 3? Side note, I really love how the mom has the child faced away from the window so that the light is not an issue for the child. Not a distractor, which is really cool. Lots of people coming in with Phase 1 or early Phase 2. So, this one always tricks everybody. And so, the Phase 2 for this point in time is what I considered it because this would be most appropriate for a child who is in late Phase 1, early Phase 2 because we're expecting the child to pair vision with function at mealtime. They're making eye to object contact and it relates to the goal of Phase 2, which is pairing the vision with a function. And so here they've utilized a feature that likely gained the child's attention in Phase 1, which was the single color, red, mylar material, it's that bow. It's going to indicate that movement to the brain. And the child is demonstrating that eye to object contact, which you would no longer see in Phase 1. In Phase 1 they're only using that dorsal strength vision. I hope that makes sense as to why this is more of a Phase 2 activity. So, in this activity -- we're moving to the next one. This image is from the Perkins' website so I'm sure some of you have seen it before. I have seen it on lots of their materials. Another great resource for some courses on CVI. They have some great webinars and things like that, just like Texas School for the Blind does. Here they have a child who is in a wheelchair and they're presenting a mylar pompom to her peripheral side and the child is turned toward the object. So, do you think this one is Phase 1, 2, or 3? Lots of Phase 1 coming in. So, I agree. It's Phase 1. So, this intervention would be most appropriate for Phase 1 as it is not directly related to a function or a characteristic. In a task like this we are looking to build that visual behavior, which is the goal of Phase 1. If you look closely in the image you can actually see that while her head is turned, she is really demonstrating that classic -- I'll go back. That classic looking through. So, her eyes are almost like looking just past the image and it's showing that she's using that peripheral vision. She has that dorsal stream vision being accessed and this is a very classical Phase 1 type of behavior that you might see. Now, this is another one that tends to be tricky for some people but this image is from the pediatric cortical visual impairment society website. They have done a really nice job of updating their website and providing some great resources. So, they have medical professionals, educators, and families all working together in a society to kind of get more information out there for children with CVI. But in the image it shows a tablet, so that's the device with the picture of the same toy the child is holding. The child is sitting at a table holding a bus toy. And then the picture of that toy is directly behind that child. And so, do you think this might be Phase 1, 2, or 3? I like that somebody specifically said late Phase 2. Phase 2, Phase 2, Phase 3, Phase 2, Phase 2, Phase 3. So, lots of different -- we have some question marks going in there, not really sure. Everyone is like late Phase 2-ish, Phase 3. I said Phase 2 for this one and the reason I said this was we are demonstrating that bridging the gap from the real item to pairing it with the two-dimensional image on the back-lit device. To me this was likely a Phase 2 activity. I wasn't here for this child. I don't know how they were utilizing it but based on the image I was guessing it was a Phase 2 activity because we would expect a child would participate in this activity to be able to make eye to object contact and sustain that. And on this side note, I would encourage a team to do something like this where you have an image displayed with a plain background on a back-lit device and present the toy afterward as an effort to build capacity for future devices as well as an opportunity for building some pre-literacy opportunities for your child. Then we have this next activity which is from the bridge school and this is a great resource for you to access information on children with CVI and complex communication needs. They have had some webinars they have offered in talking a lot about that, but they have been diving into the CVI population a lot more and making sure they are meeting those needs by working directly with Christine Roman Lansky. You'll see on the bottom half of the tablet or whatever device -- I'm not sure if it's a communication device or not. But on the bottom half of the device you see four letters in each corner. So, U, S, G, H. On the top you have letters that I'm assuming the child has selected. In the image it shows the letters A, G, G across the top separated from the letters on the bottom. What phase do you think this is most appropriate for? Phase 1, 2, or 3? Lots of Phase 3. Absolutely. This is definitely a Phase 3 activity. This is two dimensional provided with backlighting and definitely would fall into that Phase 3 area. Not only is the student able to identify letters individually but she is using four at a time and has the word separated at the top of the display and so it's giving more of a complex array for the child. As we continue through that data-driven cycle, we collect the data, we know where the child is at, what phase they are in, we analyzed that and figured out what they need. The family would start making those instructional decisions. Knowing what phase the child is in isn't really enough. We have to know more about the child. We can kind of sort through and pick things out. Now I can go through and look at activities that are all over the -- we have things on Perkins and Texas and YouTube and Facebook and everything else that are out there and there's all kinds of things. You can kind of figure out which realm of activity and how I might use something. But making those instructional decisions and making it individualized is what's the next step. Dr. Roman says mere exposure to visual input is not sufficient for individuals with CVI. So just having that exposure and saying it's there isn't enough. And so, my example to you is you wouldn't just simply bring Braille into a learner -- so you decided through your learning assessment that you have a Braille learner. You wouldn't just drop off their Braille books and walk away. That's exposure to literacy. That's not enough for them. They need that direct instruction in order to understand what's happening. And the same goes for our students with CVI. And so, I'm going to leave you with this slide here, this is our last one that we'll go through today before I answer any questions that you guys might have and giving you your closing code. In the world of CVI we would need to take the assigned path, align the content with what is needed to meet the student's needs or modify the curriculum. Then we're going to align the visual input to meet the student's needs by accommodating the images and text. That next step is what we're going to get into in part two, which is scheduled for April. And so, we're going to really get into the nitty-gritty of how to take something from what is provided in the curriculum and really making those needs met for our learners and choosing activities that are out there and we have access to those tools, so really making sure that we're not just grabbing something because it's labeled CVI-friendly, and make sure that it's truly individual for the child we're working with. Thank you again for joining me today. A little cliffhanger there. We will be back in April. If you have any questions, type them in the chat now and we will go ahead and try to answer those for you before we close out today's session. 

So, Lynne also wanted me to point out to that. When you do the CVI range, you have rating scale one and two. You get a number from rating scale one and you'll get one from rating scale two and those two numbers create your range. Typically, they're going to be close to each other. You'll get a 3 to 3.5 or maybe a 3 to a 4 but they should be pretty similar along the CVI range. But you're getting those two numbers and that's what's putting you in Phase 1, 2, and 3. So I hope that clarifies what I meant earlier by those CVI range scores. Lisa did ask too about the determining services for students with CVI. There are several tools out there for determining services for children with ocular visual impairment and a teammate and I are working on trying to create something that would help you kind of guide services for children with CVI, but that tool is not yet available. We haven't put that out for publication just yet. Be on the lookout but I don't have that available to you yet. I know some people use Michigan's and the Texas pages and things like that for utilizing their services for right now. So those are definitely things you could check into. And then I have a -- there's one that says I have a child with CVI Phase 3, one of they are accommodations is she should not be asked to interpret diagrams. So how should her learning be supported when they are using information from pictures, photographs, and texts? That's a very specific question. I would be happy to try to maybe talk to you one-on-one, if you want to e-mail me. I will go ahead and put my e-mail in the chat and we can kind of talk a little bit more because depending on her specific needs, that might be addressed differently and we will be going into a little bit more of that in session two as well. Hopefully you'll join us for that. But in general, I would say you have to break down the image so she still has access to some images because in Phase 3 you should be able to interpret some two-dimensional images. So, it's about making sure the two-dimensional images are at a level she's able to interpret. That's the kind of short and quick for that one. 

>>Kaycee: A question from Sarah. Is the CVI range valid when the range [Inaudible]. 

>>Stephanie: No, I have never had that given before. No, I have only ever had the CVI range given. So you get -- when I was talking about those scores of where they should be, I was just saying that when you are giving the scores on rating 2 that those -- when you're circling those are typically going to fall within that realm in order to get a score that would fall within Phase 2 or 3. You might get a child who has a lot of zeros and .25s and that will put you in the Phase 1. You might have a child who has a lot of .25s and .5s and that's going to put you in the early Phase 2 because you're going to score, when you add all of those up together, you're going to get a score that falls within that early Phase 2-ish realm. I hope that makes more sense. Thank you for asking that question.