TRANSCRIPT - O&M VISSIT: An Innovative Tool for Determining Recommendations for Type and Amount of O&M Service Ð 4/25/22

>>Kate: Hi, everyone. We're going to wait just a couple of minutes. We'll get started at 3:00 on the dot, or whatever time it is wherever you are. We were talking about that earlier. All these time zones of people that are joining us. It's fun but sometimes it's confusing to keep track. If you want to let us know where you're joining from, that's always fun for us to see. So you can just in the chat just let us know where you're at today. As you're doing that, you can take just a moment and change that drop down menu in the chat box to say "everyone." That way everyone can see what you've got to say. Hondo, Texas. Did I say that right? Is it Hondo? Because nothing in Texas is pronounced the way that it's spelled, I have learned. Oh, good. I got it right. Thanks, William. More Texas, ooh, Nashville. I was just there like a year ago. New Hampshire, welcome. Some Pennsylvania. We'll wait like 30 more seconds and then we'll get started. Las Vegas, New Mexico. Cool. I don't know if I knew there was a Las Vegas, New Mexico. Pleasanton, hello, Laura. I got to meet her in person a couple of weeks ago. That was awesome! Okay. Well, let's go ahead and get started because I know that Dr. Darst and Dr. Pogrund have a lot of information for us so I'm going to start with a few announcements and then we'll turn the time over to them. So, again to everyone, welcome. We're glad that you're here with us. Today it's rainy in Austin. If you have a question or a comment during the time that our presenters are talking, please go ahead and post that in the chat box. Again, make sure that your chat box says "everyone" so that everyone can see your comment or your question. Your microphones and cameras are automatically muted so you don't need to worry about those. The handout for today's session has been shared in the chat so that you can see that immediately. We'll continue to share it throughout the presentation. Later, it will be available along with the recording of this session and the transcript information and the chat information as well. You can find that information at tsbvi.edu/coffeehour. To obtain your CEUs or your professional development credit, you will respond to the evaluation that will be e-mailed to you from our registration website, escWorks. And then you'll enter the code that I will give you at the end of this session. So no opening code, just a closing code. And we'll stop the presentation at five minutes to the hour to give you that code and a few closing announcements. All right. Without further ado, I'm happy to introduce today's presenters. We have Dr. Rona Pogrund and Dr. Shannon Darst. 

>>Dr. Rona Pogrund: Good afternoon, everybody. Today we're going to talk about the O&M VISSIT, which I imagine many of you are already familiar with. But some of you may not be. But it's a fairly new tool. It's been around several years for determining recommendations for type and amount of O&M service. So I want to start out by just acknowledging the service intensity subcommittee members. This is a subcommittee of the Texas action committee for education of students with visual impairments and it's kind of been evolving for some time but the people that actually help develop on the development team for the O&M VISSIT are myself as chair and Chrissy Cowan, Shannon Darst from Stephen F. Austin, and Kitra Gray was involved in the early stages until he retired. Tracy Hallak helped us, Cyral Miller, Michael Munro. Heather, Cecilia Robinson, Mary Shore and Chris Tabb. I want to acknowledge that all of them contributed at some point or throughout the entire development of this tool. So what is the O&M VISSIT? So O&M VISSIT stands for orientation and mobility visual impairment scale of service intensity of Texas and the purpose is to assist O&M specialists in recommending the type and amount of O&M services for all of their students. And when we talk about type of service, we're talking about both direct intervention as well as collaborative consultation. And the main focus of this tool as opposed to some other tools that have been out there for a while was that we totally focus on student need based on evaluation data. That's how the tool is completed by first doing your evaluation and then figuring out what priority needs there are for your students. And questions always come up is this appropriate for all students with visual impairments because you may be familiar with the severity scale. They have one for O&M and VI and they have broken those out with students without additional disabilities and students with additional disabilities. The VISSIT will work on any student. You will be evaluating the areas that are appropriate and make sense for that particular student at that particular time. So it is designed to work with students from birth to 22 and primarily in an itinerant teaching model. It was designed for itinerant O&M specialists in the schools. So that's the way it was designed and hopefully you can use it that way. Okay. Let's move on. So a brief, brief history of the VISSIT. First there was the creation of the VISSIT and that was for teachers of students with visual impairments. And that was developed actually starting in 2010 and we completed the initial validation study within Texas in 2014 and a national validation study was completed in 2015 and we determined at that time that this tool was a reliable and valid measurement of needs of students. And the VISSIT is all around the ECC. The nine areas of ECC. So it comes from evaluation data for ECC evaluations. Now of course O&M is a piece of that but the way it is on the VISSIT is just things that the TSVI would do as far as their role that has relation to O&M, basic skills, orientation, things like that. If you are interested in reading more about those studies, the initial study in Texas was published in November/December 2015, critical issues, and the national validation study was published in 2019 and the authors of those were myself, Dr. Darst, and Dr. Michael Munro. The O&M VISSIT evolved from that. As we developed this we had O&M specialists say we want a tool like that. We want one similar. So because of that we kind of continued on. We changed the makeup of the original subcommittee because it was mostly people that were just TSVIs and not O&M specialists so we added quite a few people who were dual or O&M into the group and other people that had helped us earlier. And then we did -- we first met in February of 2015 to develop the tool and we actually found it harder to develop than the regular VISSIT for TSVIs because that was around the ECC area and the O&M curriculum, as you all know, it's just gigantic and we had to figure out how to not have a 40-page tool for people to use so we spent quite a bit of time just trying to figure out the categories and making sure that everything was covered somewhere but may not always be interpreted exactly the same way by everybody. And we completed an initial field test in September 2015 for that. We completed an initial validation study in Texas in 2017 and the final national validation study in 2019. And the initial study from Texas on the O&M VISSIT, if you're interested in that, was published in -- the international journal of O&M that I don't think exists anymore. They have changed it to rehab journal, but it's out there if you are interested in it. And then the article for the national validation study, we are in the process of completing. And we'll hopefully get that done here shortly and submitted to JBIV in the near future. Let's take a brief look at the tool and we're going to give you an example later on when Dr. Darst goes through and walks you through how it's completed but I want you to get a familiarity of the layout. So it's very similar to the one for the VISSIT in that the way it's structured is the type of O&M service and we have one column at the top for direct instruction for O&M specialists and then the second column is called educational team support/collaborative consultation. Those terms are intercharged. And the scales are exactly the same as well in that it's you either have to put a zero for no need, a one for low need, a four for medium need, and that kind of describes what that means, and seven for high need. Priority and then a ten if it's acquisition of new skills, which is intense need as a priority. So we use those zero, one, four, seven, ten numbers on all of these tools and if you have questions about that, you need to Dr. Darst because she's the one who came up with why we do it that way. But it works. And the same thing from no need to intense need for family or other team members that need a lot of modeling, that same sequence of ratings are what you're going to choose from. I'm just going to show you a couple of pages of the tool now because you'll see the whole thing a little bit later in the presentation. But we have each area is an O&M skill area and we came up with a broad topic purposeful movement is this one that you're looking at. And it is divided into motor skills, basic skills, and cane skills. And we have a little brief definition for all of these, which for motor skills is anything to do with, you know, head and trunk control, rolling, crawling. Younger students are students with significant multiple impairments, gait patterns, reaching, exploring, et cetera. These are not inclusive. They're just examples of the kinds of things that our group thought should go in that. Then we have basic skills, which is a technique and alignment, search patterns, landmarks. Then we have cane skills and that's all the things about, you know, cane skills and the prerequisite skills of grip and cane and can include things like three-point touch, using the verification technique, recovery skills, and we also have adaptive mobility devices under cane skills. So you'll see in a minute how you put in a number for each of these areas and for some students, at a particular moment in time, you might be giving them zeros on things because they don't have that need. We're talking about a middle school student, they probably have their motor skills intact unless they have significant other disabilities. Which you could be working on those for kids in active learning stage. So it's really individualized based on the student. And then at the bottom the numbers you'll see will automatically add up and they'll pop into the bottom for each page. Let me go on to the next page. And this is just a real brief overview without the descriptions but you will see them if you look at the tool yourself to see how we have broken it up. We have communication, which is receptive and expressive. And, you know, we had a big discussion about this that, well, you know, the speech therapist does communication. The classroom teacher. But we were talking about communication related to O&M and both receptive and expressive. Can they attend, can they follow directions, choice making , you know, can they express wants and needs and things like that that impact your O&M planning, so that's why you would want to know that related to O&M. But you're not doing, like, the complete communication evaluation. That's not what this is about. And then the big area is concept development. You'll see some of the areas have a lot more breakdown sub parts to them and that was done purposely because we felt like certain skill areas require more intensive time, many cases. So therefore, like, such as concept development, it's broken down into body awareness and directional/positional concepts, spatial awareness, comparative concepts such as categorizing objects and, you know, opposite textures, soft and hard, things like that. Environmental concepts is huge. That could be at home, school, the community. All the environments that would be appropriate for a particular student at a particular time. And then we also included maps and tactile graphics under concepts. You know, using tactile, print, auditory, compass orientation, tactile symbols, keys and legends, functional use of maps. That's a pretty broad area as well. And then the next group of skills is assistive technology for O&M and we have it broken down by optical devices, low tech and high-tech devices and things are obviously things related to O&M so, you know, your optical devices might be [Inaudible] depending on the student, you know, devices that they might be using, magnification, telescopic, bioptics that they are going to use in functional activities. Low tech is do they need sunglasses for glare and a Braille compass for, you know, a long cane. That's low-tech AT. And, et cetera. Curb feelers on their wheelchair, whatever. And high-tech devices would be more things like, you know, the use of video magnifiers or electric travel devices, GPS, apps they use on their phone. Talking compasses. So anything that's hooked into one part of O&M or another that is higher tech. And then we have a section on critical thinking and problem solving and on that one we're looking at things like route planning, which does take a lot of critical thought. Recovery strategies, how do they handle unexpected events that occur on a lesson or when they're in the community. Emergency contacts, things like that. Adverse weather, you know, things happen. And so is that an area they need some work on or not. Environmental analysis includes gathering and application of information related to -- it could be layout of a room or a building or address systems or traffic patterns, safety, contrast and lighting issues. Transition to new spaces, anything where they're having to analyze the environmental would be considered under that category. Street crossings is a separate section because that is a lot of what we do and that takes time. And that's really just synthesizing necessary skills and strategies to execute safe street crossings. And we weren't breaking those down because there's so many that you would just, based on the evaluation that you do, know where that student needs help with street crossings and that would be what you would focus on. The next area is sensory efficiency and that is broken down in visual, auditory, tactile, and then we did have proprioceptive, vestibular broken out and it was getting so incredibly long so we decided that section was going to be together, proprioceptive, vestibular, olfactory. And then but you would also be talking about their, you know, their visual sensory efficiency which would be with or without optical devices, how do they deal with lighting, glare, spotting, tracing, all those skills that we teach. Auditory is things like, you know, how do they use sound and discrimination identification, localization, directionality. Sound shadows, what's the impact of cochlear implants or hearing aids for a student who is Deafblind. So all of that goes under auditory. And then the tactile includes tactile sensitivity reduction, if that's an issue, discrimination of all kind of shapes and textures and tactile warning systems. Do they recognize terrain changes? Effective use of signage and numbering systems like Braille or symbols or et cetera. So that's what goes under that. And then we have -- oops -- transportation. So transportation, that sounds like a good category, kind of gigantic, but we have broken it down into familiarization and planning, which is access and public transportation, planning a bus route, knowing how to deal with schedules and getting the information you need where utilization is actually the use of public transportation like care transit or ride share or buses or taxi, air travel, whatever is appropriate. Those are kind of big categories but once again you would make them specific to the student. We included a section on health and safety and health we were talking about that, related to O&M again. We're not doing a health screening, but that includes strategies for managing health conditions, which a lot of our students do have. Medications, can they manage their own or not? First aid, their stamina, is that an issue that you might be able to teach more but they can't handle it. Effects of environmental conditions on personal health that are connected to travel. And then safety we were talking about strategies for safeguarding self and personal belongings, particularly throughout the community. Selecting safe routes, awareness of surroundings, emergency protocols, how do you get out of a dangerous situation. So we included that because so often when our students are in the community that those are concerns about their health and/or their safety. So we felt like that's an area that does need to be addressed in an evaluation. And then we have a whole section on all the related ECC areas to O&M. Because, as you know, they all relate. Social interaction skills, you know, how do they have personal boundaries. How do they communicate with people out in the community, you know, asking for help, interacting with people, et cetera. I'm not going to go through that because you guys know what the ECC is, I would imagine. We have self-determination skills and that's hugely important in O&M, self-advocacy, assertiveness, those kinds of things. Independent living skills are things like money management, if you're going to go to the score, personal information, identification, personal hygiene, dressing for the weather, et cetera. Shopping, all things are connected to O&M. Recreation and leisure skills are things like identifying and investigating different recreation and leisure options in the community. And then career education is commuting to and from a work site, perhaps if they're on a job, or time management related to employment. Safety and accessing the work environment. And then orientation through motorization. Then we're going to go to the last page. After you filled out all of those items that you'll see here in a few minutes with Dr. Darst, for each category, whether it be zero up to ten, whatever it is for that particular student. Those numbers will pop in electronically automatically to a PDF that this adds it up itself into this last page, which is a direct instruction column and an educational team support/collaborative consultation column. That's what A and F are but then we have a B, C, and a D under "direct" and that's looking at things like some other contributing factors because we realize that when you evaluate a student you're not necessarily going to know about those other factors. That's not going to come out of an individual evaluation or even interviewing parents but you need to go a little bit further to find out if any of these factors would make a difference to either increase or decrease recommended time. And let me give you -- I'm going to flip over to this particular -- no. Wrong. Okay. Transition is talking about if you have a student that's transitioning to a new environment. Let's say it's home to preschool or middle school to high school or high school to college, wherever the transition's happening. A lot of times those, getting oriented to a new environment, working with the rest of the staff about the student coming to that environment takes time. So in that case you would get an extra ten points if there's a transition anywhere in that student's life at that particular moment when you complete this. That gives you ten extra points, which equates to more time to be recommended. Then there's a contributing factor of medical status and condition. And this one can go either zero, because it's -- medical is not an issue. It can go minus ten, take some time off because let's say the student has higher needs but they can't receive service because of their medical condition. You know, maybe they're having constant seizures, maybe they're medically fragile. It could be any number of things that they're not able to work with you as much as you know they need. So that's a way to reduce the recommended time by taking off ten points. And on the flip side of that you can add an additional ten points to the medical status and condition because sometimes that's going to make you have to spend more time with the student because of that medical condition. So it can go either way, depending on what the needs are of the particular student. And then the third group of contributing factors is time-intensive instruction. So in that case you want to think about am I going to be -- are we doing heavy bus travel where I have to travel to a place and they have to take a long bus ride and et cetera, et cetera. And I know that's kind of the phase of O&M we're in. It's a lot more community travel. It just takes longer than a 45-minute lesson so then you might want to be building in that additional plus ten points there because those kinds of activities take longer and so this is a way to boost that up in terms of the time. And then you have the same thing on the collaborative consultation, contributing factors. Are you going to have to work with the team for transition, and that would get a score to add points. Same thing with medical. You have to work more with the parents or the nurse or the caretaker that takes care of that student who has specific multiple impairments that are health related. And then time intensive, sometimes you have to work with other team members and the family that take more time than you have already put in the rest of the scale. So then and then the J, that's where I was skipping to that I skipped too soon. We have an additional chart here that's called additional areas of family support, AAFS table. And that table actually you use the same 041710. Is there a need for consistency of educational concepts across school and home. You're going to have to work more with the family on communication systems or independent living skills or things like that with the family. And that's going to take extra time, then you would add those points in. Connecting family members to outside agencies and support. Are there related agencies, camp, respite, things like that that you have to take time to do with the family. That would add there. Or if there's no need, just put a zero. Helping them participate in special ed meetings and medical visits. If there's cultural and language differences. If the family of a young child is having trouble with bonding and interactions you might have to spend more time. So this is a way to give you that additional information about those particular family needs and then that would go back under J, because that's only under collaborative consultation, if that's an issue or team support. All of those come out and you add them together. So let's keep going. I'm going to do a few -- we have a whole bunch of frequently-asked questions and I'm going to go through a few of the more common ones so that you can be familiar with those in case they come into your head. So one question is can the O&M VISSIT be used for all students who receive O&M evaluations to require service as well as those currently on my case load, including those with multiple impairments, Deafblindness, or medically fragile. How about infants and toddlers? The O&M VISSIT is designed to determine appropriate type and amount of O&M services for any student because of their visual impairment requires O&M services and that can be direct and/or collaborative consultation. So it includes all of those students. Is the O&M VISSIT to be used as a case load work load analysis tool? And the answer to that is no. The O&M VISSIT is only part of a work load analysis process to take into account all of the issues related to work load. So it is not designed for that. It's designed just for that, how much time you need to spend with the student and their team and family. And so the O&M VISSIT only determines type and amount of service needed by individual students. Not things like planning time and travel time and all of that. So that's a different tool that's coming. We're working on something called the VISPA, if you haven't heard about it. That came out of this because we were asked what about those other lesson plans and checking out environments and all the many, many things that vision professionals do. So this tool that's coming, the visual impairment of -- visual impairment scale of staffing pattern analysis will address all of those things and you include your results from the O&M VISSIT for the visit and for that tool but we're not going to get to that today. That's another presentation. How do I determine the intensity of student need? Well, you gather data from your O&M evaluation and/or progress, reporting, and monitoring. You would take data regularly and then you use the O&M VISSIT to rate the amount of need and obtain the total score. And does it take professional judgment? Yes. It's not precise, that precise. You still have to use your professional judgment in analyzing your evaluation data. Do I have to complete an O&M eval? We already answered that. Yes. [Indiscernible] which includes those other evaluations, all of that has to be completed and then annually the O&M specialist can use monitoring along with observation, language to complete the O&M VISSIT as you progress and the student has different needs each time in terms of type and intensity of service. Why were additional contributing factors not included in the contributing factors section? Well, we spent a lot of time on this in the development of this tool and there are many factors that are already built into the O&M VISSIT that should be considered as you determine need for the individual student. These might include age of onset of visual impairment, behavioral concerns, cognitive level, affect of disabilities. Those have already been taken into account. Where if you look at the Michigan severity scale and they have all those other things but because our tools are focused only on student need at a particular time, really that doesn't matter because two students with the exact same visual diagnosis, exact same age, the exact same -- behaviors, whatever, intellectual disability can have very different needs because everything is individualized and it depends on their home life and their experiences and their education, all of those things. So that's why we felt like the ones that we included were ones that weren't embedded already in the tool, if that makes sense. Let's see, I have a few more questions. What do I do with the O&M VISSIT once I have completed it? Since the O&M VISSIT is used to help the O&M specialist determine the type and amount of services provided for students, it should be included in the student's educational records. So it should go along, you know, tag on to the IEP and any permanent record so if somebody else comes in or the student moves at least they see what your evaluation data showed and why they were getting the amount of service they were getting at the time. Should the value of intensity reflect the services I am currently providing? No. Not necessarily. The O&M VISSIT should not be used to justify your current level of services but should be used as a predictor and recommendation for the appropriate type and amount of services needed by the individual students. So you don't want to mark it in a way that just supports what you're doing if based on the evaluation data and your professional judgment you know you're not giving the student enough time. Then you've got to, you know, honestly complete this tool, not just do it to match what you're currently doing. That defeats the whole purpose of it. What if the O&M VISSIT indicates the need for more service time than I'm currently able to provide? After you have completed the O&M VISSIT on each student you can use this information to look at your work load activities before we get this eval. You can do that yourself, do a time study of what you're spending time on. Conduct a work load analysis and present this data along with your findings from the O&M VISSIT to your administrator or your team to decide if maybe additional staff is necessary to meet the needs of your students. If you are way over your hours then something's wrong with this picture. That's how you can use all of these tools to help your administrator understand that I'm not providing enough service that my student needs. And a lot of times we know that but we feel pushed into another referral, another evaluation, another referral and we've got to squeeze them in somehow into the 40-hour workweek. This can help you to really be able to go to your administrators and team and say what can we do differently. Maybe we have to hire a part time contract person. Maybe we have another position next year. Maybe we divvy up students differently so there's a lot of ways to use this data. Should a student who has direct services also have time allotted for educational -- where am I? Educational team support and collaboration? The answer is yes. And our opinion all students who receive direct instruction also will require collaborative consultation services because if you just work in an isolated context with the student you're not getting any generalization or support from your team so you do have to provide information, identify areas of need, reinforce skills, ask the team members to support what you are doing, including TSVIs and family members. You might have consultation for some students. A lot of ours kids with significantly multiimpairments need to have their O&M skills integrated into their special ed classroom working with the team to make sure that happens every day, not just when you come by. But for other students if you're doing direct service you still have to talk to the team. You would have a hard time convincing me that you never have to talk to the team. So that's just kind of part of what the expectation is when we develop the tool. Sometimes travel time to an O&M instructional location is needed. How does the O&M VISSIT factor the time into the rating scale? Travel time is included in the elements of the O&M VISSIT and is considered part of the total direct service time indicated in the paperwork. For example, if travel is needed to a particular intersection, this time should be included in the amount of service recommended for the student. You have to think about that. If you have to drive in the community pretty far to the site I'm going to work in, that should be built into your need area for that particular student's IEP goal. Travel between students and schools is not counted as service time. That doesn't count when you're going from one student to the next to different schools. This travel is part of the work load analysis and not included but there is a section for that in our work flow tool. What if my student has so many needs it would take more than a year to address them all? That often happens. Each IEP should be designed to meet measurable goals and recommendations for O&M specialists should address annual student achievement. The IEP committee may need to identify priorities. Some of our students have a lot of priorities, it seems like, but you can't work on everything at once in one IEP round so you're going to have to decide about what those priorities are so programming can be focused on specific areas that are the highest priority and progress can be made. If you're working a little bit on so many things you're probably not going to have enough progress. So addressing too many needs at one time can impede progress because of intermittent inconsistent instruction so you're better off prioritizing and if you're so lucky that you meet that students' needs that you prioritized halfway through the year, you can do an amendment to that IEP or you can call another IEP meeting and say, wow, he improved so much that we need to look at the rest of the evaluation data to see what we're going to work on next. So you're not necessarily locked in forever if you misjudged. Okay. So those are just some of the FAQs, there are others on the website. I'm going to change over to Dr. Darst, who is going to do a demonstration of how to complete the O&M VISSIT protocol for a sample student. And this sample student is Ella. And Dr. Darst, you can take over. 

>>Dr. Shannon Darst: Okay, so let's talk a little bit about Ella. Now just to let you guys know, these sample students are available on O&M VISSIT website on the TSBVI website. There is -- I think there's a couple, two or three on there and we tried to capture some students who have similar, you know, similar characteristics and abilities and needs than some of your students would have. What is missing on the website that we've included on our case study is we set those priorities that Dr. Pogrund was just talking about. We actually have kind of a sentence at the end that says here's what the team and the student and the COMS have decided are going to be the priorities for this student. So if you're looking for that kind of clarification on the samples on the website, they're not there yet. Dr. Pogrund and I are aiming to help make some updates to that so that some of these things will be a little clearer for you guys when you're going in to see how we filled out our case studies that are available for you guys to look at and sample. Okay. Let's talk about Ella. Ella is a 12th grade student in a large urban school district who attends all general education and advanced, that means AP or dual credit classes. Her visual diagnosis is high myopia and cone-rod dystrophy. Her acuity is 2100 after correction in both eyes and she has been receiving services from a TSVI since her 10th grade year after experiencing difficulty accessing educational materials. Basically she's had a year and a half, two years of TSVI services. Ella demonstrates appropriate interaction skills and has many friends due to her involvement in various school clubs and activities. Ella demonstrates adequate travel skills on campus during daytime hours. She's preparing to transition to a large in-state university. Ella would benefit from the introduction to cane travel and adaptations for low vision due to the progressive nature of her diagnosis but she and her family are concerned about her missing academic time to participate in O&M lessons. Her O&M evaluation results indicate a need for skill development for night travel, independent street crossings, public transportation, and use of optical devices in addition to basic cane skills. Okay. So just to kind of highlight a couple of things so that everybody knows what we're going to be looking at when we fill out our O&M VISSIT. Number one, you noticed on here her evaluation -- O&M evaluation results indicate, just like Dr. Pogrund said and we want to just reiterate this ad nauseam, the VISSIT and the O&M VISSIT are tools to be used after an evaluation is conducted, okay? So we want to make sure we have a really solid O&M evaluation to use before we fill out our O&M VISSIT. And, again, you know, you want to notice that she does have a progressive nature to her visual impairment and she does use correction and she seems to be accessing most of her work at school just fine. So a lot of times we may hear people say, well, they're doing fine on their schoolwork so they really don't need any extra services. The deal with Ella, she's going to be transitioning to a new setting. She needs some independent travel skills, independent orientation skills that she doesn't have right now. Remember, it says her family and she are both concerned about her missing academic time to participate in O&M lessons right now. So that means that before we go into this we need to consider here's what Ella's needs are going to be. Here's what Ella's academic and her family, like their academic bent. So we need to think about that before we actually do any recommendation of time at the end. Okay. Dr. Pogrund is going to fill out the actual O&M VISSIT as we are -- like in realtime. She's going to switch her screen and so basically she went to the O&M VISSIT site on the TSBVI website and she pulled up -- this is the PDF without instructions. You can pull up the PDF with instructions, PDF without instructions, or the Word doc format and the two PDF versions are the self-calculating, somebody asked that earlier. At this time the Word doc does not self-calculate. Dr. Pogrund, I'm going to start feeding you some numbers to fill out about Ella. So for Ella's -- so here's how I'm going to talk about this. I'm going to talk about each skill area and then I'll say it will be zero for direct and zero for collaborative consultation. And so -- or whatever the number would be. So we're going to go basically from left to right on each row. I'm not going to do direct first and then consultation second. We're going to do them together. So Ella has a zero need for motor skills. She's functioning just like her peers without visual impairment. So that first line under motor skills would be zero and zero. Basic skills, including guide technique, alignment, cruising, we had a 4 and a zero in that area. And that's because she's going to be learning a few new techniques about orientation, things that she hasn't had to learn yet. And eventually be working on things like crossing the street, using a cane. We're going to be giving her some things she might already know but trying some non-visual techniques or trying more advanced skills. Cane skills. We're going to give her a 7 and then we're going to give the team of collaborative consultation a 4. She's going to be going to university, traveling on her own a lot and she needs cane skills, especially because we know that she's going to have some night travel, you know, she's going to be traveling at night and the cane is going to be very necessary during that time, so we give it a 7 and a 4. Next is the receptive, is that right? Did I skip? 

>>Dr. Rona Pogrund: The totals are at the bottom. 

>>Dr. Shannon Darst: Again, it self-calculates and each page will self-calculate and it will carry on the full total to the next, like to the very end of the tool. Okay. So for receptive, this is her communication. Ella's great in all those areas so she gets a zero, zero, and a zero, zero in receptive and expressive. And the next page is concept development. And, again, Ella is on grade level or performing above grade level academically and in most other areas of her life she is right on where she is supposed to be so she doesn't need any help with concept development, at this time. So that's zero, zero, zero, zero, and zero, zero. 

>>Dr. Rona Pogrund: That was at the bottom. 

>>Dr. Shannon Darst: On our next page we've got optical devices and we had -- there was a bit of a need for that on her evaluation so we're going to give the optical devices -- this is part of the AT piece. 

>>Dr. Rona Pogrund: Wait, wait, wait. We're still on concept development, Shannon. 

>>Dr. Shannon Darst: Did I skip? 

>>Dr. Rona Pogrund: You skipped a page. The top two were zeros. There was comparative, environmental, and maps and she did have a need there. 

>>Dr. Shannon Darst: Uh-oh. I don't have that. 

>>Dr. Rona Pogrund: Page 10. 

>>Dr. Shannon Darst: No, I don't. It went from 9 to 11 to 11. 

>>Dr. Rona Pogrund: We gave her a 1 in math and tactile. And why was that? 

>>Dr. Shannon Darst: Well, because that's -- she's going to have to be learning how to use public transportation and she's going to need to learn how to use some functional AT for looking at bus routes, planning routes. Again, she might be able to get it electronically but we also want to teach her how to do that tactilely -- not tactilely but visually if she needs it. Okay. Now we're on optical devices. So weird. All right. So we gave her a 4 on optical devices. And a 4 because we're going to start working on things like some magnification and some telescopes or, you know, monocular views for when she's out traveling on her college campus. Low-tech devices, again, like we are working on some things related to her cane travel, if she's traveling at night, does she need a flashlight or task lighting. So we want to go ahead and not make that a huge priority but it's something we need to start talking about. And then with her high-tech devices, we're going to give that a 4 and the team a 1. And we're giving her that because, again, we're going to start teaching her how to use her technology, like the phone or tablet to help her with some navigating, to help her with public transportation, to help her with planning routes and that kind of thing. Okay. Route planning is next. And, again, we're going to teach her basic route planning using her cane because she's going to learn some basic cane skills. We're going to give that a 1 because we're not going to be working on lots of non-visual things right now like street crossings but we want to teach her how to do some routes. Recovery strategies or unexpected events. We're going to give her a 4 there. And mostly that's going to be some things like alternative modes of transportation, night travel. We noticed that that was a priority from her evaluation and from talking to her team. And zero on the team part at this point. Environmental analysis, 1 and zero are the numbers that we got. And again this has to do with, like, just learning layouts of new places and how to go about that in a systematic and efficient way. Okay. And then our next piece is going to be street crossings. Again, we're going to give that a 4 and a zero. We have a lot of zeros right now because we really are just trying to focus on working with the student because of her age and her skill level but there are some things we're going to talk to the family and the other team members about, but a lot of this is going to be focused on working with Ella. Sensory efficiency, we're going to give her a 4 there and a zero in the right-hand column. We're doing that because we're going to try to help her with doing some scanning and tracing and tracking using some of that AT and that kind of thing. Thinking about different lighting conditions where she's going to be in her new environment. We need to give her some skills in learning how to adapt and cope with those things herself. Auditory, same deal. We're going to try to do some non-visual training because she does have a progressive visual impairment and it's zero in that other column. Okay. And then we get down to tactile. We're going to give that a 1 and a zero. And we're giving it a 1 because we want to introduce some things to her but we're not going to have like high skill, just a 1. Not high-skill training in that tactile sensory efficiency. And zero and zero in the other sensory systems. And then with transportation, again, we had talked about that -- no, I'm sorry. We're at familiarization. Right? 

>>Dr. Rona Pogrund: Transportation but familiarization planning is first. 

>>Dr. Shannon Darst: Okay. So we're going to do 4 and zero and 4 and zero. So familiarization and planning, again, we're just talking about introducing her to being able to travel alone using public transportation and alternative methods. And then the actual utilization of that. So planning and using public transportation. Sorry. That's my bell. We better get hurrying. Okay. So for health, we had zero and zero. And for safety we had 1 and zero. Again, the 1 is just to make sure that she learns how to travel safely and be aware of her surroundings when she's in a new space like she is going to be at college. And then for related ECC she has zero and zero in social interaction skills. She's great with that. Right where she's supposed to be with her peers. Next page is self-determination. We gave her a 1 and a 1. And mostly this is because of the self-advocacy piece that's going to come along with learning how to travel independently and travel at night using a cane. Independent living skills, 4 and zero. Again, that transition thing that she's going through, she's going from high school to college, living on her own. There's definitely some things that her O&M specialist needs to help her work on with time management and dressing for the right weather and organizing skills and that kind of thing. Rec leisure is 1 and zero. She's going to be needing just new skills to get to and from some of these places that she really hasn't had to do on her own now that she's going to be off at university. So when we get down to that final page, we're going to see that our direct instruction subtotal is 59 and the collaborative consultation subtotal is 11. We're going to go ahead and give her in box B we're going to give her a 10 and also in box G because she's going from high school to college. She's moving from one city to another. There's a lot of transition happening. For medical factors, we're going to be giving her a zero and zero. There's nothing right now that seems medically imperative that's going to affect her situation. And then for a time-intensive instruction we're going to give her a 10 because she's in 12th grade and she's going to be graduating soon and moving to college. Zero in the box I. If you could go down to the AFSF table, Dr. Pogrund -- I'm going to try to run through these really fast because we're out of time. 4, 4, zero, zero, zero. And so 4, we're just trying to make sure. Connecting family with agencies and places on campuses and the other three are zero. If we go back up to the previous page, you'll see that the 8 from the AFS is filled in. We have a 79 in our direct subtotal and 29 in our collaborative consultation. So if we can go down to the first page for the recommended schedule of service minutes for orientation and mobility. The 79 fits into the category where the recommended range time is 45 to 60 minutes a week. And what we have decided to recommend for direct service is 60 minutes a week. And here's how we would put that into our schedule. 60 minutes one time a week, maybe longer periods will be needed for transportation lessons or community-based instruction as appropriate to prepare for transition after high school. Lessons will be scheduled outside of school hours in order to accommodate for Ella's desire to stay in classes and to address night travel. And then the second part says student was being seen 15 minutes a month by previous O&M specialist. I overtook this case load this year. Ella did not want to miss any part of her school day to meet with an O&M specialist. She makes it clear that her class has met more for her future success. At this point we're still going to be recommending the 60 minutes a week but we're not going to be providing that in the school day and we would write it in in this part, the explanation and justification. And then the second part -- oh, I got one minute. The No. 29 falls in the category of 10 to 15 minutes a week of working with the team, collaborative consultation. We'll do 30 minutes two times a month and this will be addressed with Ella's family. She's not really needing any O&M team collaborative consultation during the school day but she is needing that at home with the family and during night travel, so that's where that collaborative consultation time is going to come in. Okay. I think that's it. We are on to our next slide. You can go back to the PowerPoint, Dr. Pogrund. We have about 20 seconds. 

>>Dr. Rona Pogrund: I think there's nothing else except questions and comments, which are coming in the chat, I assume. 

>>Kate: We did have one question that I don't think has been answered. Can two O&Ms come and do a visit on the same student and come up with direct on one and consult on another. Would you need to consult with the family and other O&Ms to get a more accurate VISSIT? 

>>Dr. Shannon Darst: I'm going to say that if you're coming up with no direct on a student that there might be a need to make sure that that evaluation is accurate. And here's why. If the student really doesn't need any direct service work from the O&M instructor you're saying basically I'm only going to work with the team, I never need to work with the student, is the evaluation then showing that that student isn't qualified for O&M services? That's the way I would address it. I'm not speaking for Dr. Pogrund. 

>>Dr. Rona Pogrund: Yeah. I don't know if that answered but that's what I'm thinking. 

>>Dr. Shannon Darst: Again, when we are saying conducting evaluations and doing a VISSIT or an O&M VISSIT, you don't base it on what your time allows. You want to base it on what the student need is. So if somebody is saying I'm putting this kid on consult because I don't have time to provide services, that's not okay. 

>>Dr. Rona Pogrund: That defeats the whole purpose. 

>>Dr. Shannon Darst: I hope that helps.