I chose this question because I feel it is such an important aspect of how we support, guide, and build strategies alongside the family and education teams for our students with CVI (and also those who have not officially been diagnosed with CVI yet). The article “CVI Interventions: A Call to Action in the United States” by Drs. Bauer and Lueck is something I might recommend a few of my special educators/case managers read (in all their free time…) because WOW it spoke to me and I think gives a great synopsis of where we are right now for supporting students with CVI.
There are so many important threads in this, but the big take away I would hope they might gather is that while it is not (yet) an easily nailed down system to implement that it IS a very worthwhile and important effort. And that unlike other visual impairments it will require some creativity and flexibility from all around the student. Collaboration is key, and incorporating feedback from home and combining with school observations is critical.
We always want to include and put as a primary information source the family and what they observe with their child. I think the double edged sword, so to speak, here is that the school team will likely see quite different visual behaviors as the environment is not as familiar or predictable. And as the school team we want to always be incorporating information from home about what the challenges are and family goals so we can weave those into the program planning and strategies at school. We of course know as educators that the family spends considerably more time together than the child does in school, so we should always be inclusive of their priorities.
And this is part of why I find CVI so fascinating and weighty - I think more so than with most other visual impairments it is misunderstood and easily “ignored” by schools because the science isn’t quite as firm yet as it is for something like strabismus or low acuity. Those are tangible and CVI can feel slippery and hard to nail down. But as TVIs I think that puts more emphasis on us to educate and encourage both families and school teams to remain vigilant and encouraging about it. I often find, especially with school teams, that when I explain things (as best I can) like why fast movement gets missed or is stressful to a student there is often an “ah ha!” kind of expression and some connections. Or why the student might get frustrated in art (very complex room). Yes, most education teams are stressed and overloaded but I also have found without exception that they want to do the right thing. One of the many things I love about being a TVI is the collaborative nature of the work, and CVI definitely requires us to hone this skill so our students can have the best outcomes.
Hi Robyn. I very much agree with your statement that we are “expected” to know it all and have concrete answers. I understand why schools and families feel this way (especially with our model here in VT where all the vision services in schools is through an outside agency and the TVIs/COMS are not officially part of the school staff). But this is where relationships and connections along with trust building is critical. I have also experienced the effects of some successes leading to more buy in and engagement. But especially with CVI there remains this lingering sentiment of “I know the doctor says this student has this intangible diagnosis but what we’ve always done should work”. I have amazing teams on my caseload (all of whom have SO many students to support) and we have largely gained trust for one another, but sometimes the progress is not immediately evident and that can be tricky. It is such a long game with achievements along the way. I find myself often requesting that the student is allowed wait time - let the student process what they are seeing. I think this is a very important part too!
Thanks for your post!
Hi Akeyah. I appreciate all that you’ve said in your post - and especially the concept of supporting CVI as a sensory impairment. When we can reduce the sensory input for a student I’ve seen it make such a difference in their using vision. And one that I think gets overlooked a bit is being securely seated. I have a student who (this was years ago) was ignoring books and did not engage with any part of exploring them. One day I asked the staff person to let him be in his activity chair at his desk space (which includes a support for his upper torso) instead of lying on the carpet and suddenly he was very interested in the books! This was early in my days as a TVI but it has definitely stuck with me how important it is to reduce the entirety of the sensory input to enable use of vision.
Thanks for your thoughtful post!
Hello Rebecca. Thanks for your post - I’ve also found that when I can meet with the team before the school year begins it definitely sets us all up for more success. It is the foundation for the year, not that it can’t be successful when started mid year but as you say it is harder.
I’m wondering with the literacy accommodations if you’ve had “push back” on providing books that are younger than the age of the class. For example, I work with a 3rd grader who I read board books with (because he can turn the pages and doesn’t destroy the books like would happen with paper pages). I’m getting some push back that we have to only provide grade level material which has not been helpful or successful. He is a very complex kiddo in a district that is significantly understaffed and overly stressed. My approach has been to meet them where they are and always offer challenge but I don’t want to close down our connection either. Have you experienced this intention?
Thanks for your great post!
I agree! This is compounded by the fact that not all TVIs are onboard with CVI..Many refuse to see students with CVI because they don’t meet the VA criteria for services..while others only see it through the typical VI model of options. Which may/may not be true for a child with CVI…Sigh..
Question 1: What tools or strategies have you found most effective in helping general education staff understand the nuances of CVI-related behaviors? What misunderstandings have been most persistent?
One strategy that has really helped me with getting the general education staff to understand the nuances of CVI is to help them clearly understand the impact of the environment on the student’s vision. I feel like when I am able to take the time to explain how clutter, noise, and other stimuli in the environment distract the child and make it more difficult to focus on what they are being asked to then the staff is able to make these changes when possible and see for themselves the impact on the child’s vision. I have gotten good feedback after sharing some of the popular CVI simulation videos available on YouTube with staff and family. They have stated that watching these videos helps to give them a better understanding of CVI and how it manifests for the student. just having a better understanding of the condition, gives staff a lot more confidence and the ability to independently work to incorporate accommodations into their lesson plans.
The misunderstanding that I find is most persistent with people who do not have a general understanding of CVI is that making something bigger or bringing it closer will help the student to see it. Even though this may not be an appropriate accommodation for CVI, it shows me that the staff recognizes that the student has a visual impairment and is trying to provide support. This is a heads up to me to provide the staff with more education and training.
I really agree with your point about pushing in multiple times throughout the school day in order to observe. I have found this to be very helpful for me, especially when working with students with more complex needs. Their behavior can vary so much throughout the school day due to a variety of factors. It is so beneficial to see the student in the regular education classroom. Their needs often present differently, and I am able to learn more about what skills would be most helpful for the child to master in order to be more successful in the classroom. When able, I work to develop IEP goals based on these needs. I am then able to work on these skills during individual vision support sessions, and then the staff can work to incorporate the appropriate accommodations for these skills into the student’s school day. Pushing into the classroom is a good way to foster collaboration and communication.
I love your idea about providing story boxes that are accessible for all! You make such a good point about staff being more likely to incorporate an accommodation into the school day when it can benefit all students. I have found when it is something that the whole classroom can utilize then it is more likely to be incorporated into the daily routine. A story box is a great way to do this!
I agree with your statement: [quote=“serenag, post:5, topic:2312”]
It’s basic human behavior to have preferences and somewhere along the lines, adults sometimes forget that children (regardless of their abilities or diagnosis) have the right to express their desires and have those desires respected just as much as the adults do.
I think sometimes we want to push skills onto students that they do not understand or learn from that method. I know that I have been teaching a for a while and it took me a long time to realize that I have to teach to the child not always to what is expect.
I appreciate how you broke this down. I know I tend to ramble. You made it simple and easy to relate as an educator. I wish I had had this breakdown 4 years ago. I know I might have been a stronger TVI to my CVI student. Plus it help me move forward with a greater understanding. I hope it is ok to copy this to keep in mind moving forward.
[quote=“hblankenship, post:1, topic:2312”]
5. What are the potential risks of applying interventions developed for one manifestation of CVI to another? How might these risks be mitigated?
The potential risks of applying interventions developed for one manifestation of CVI to another is that each case of CVI is unique to the child. There could be similarities but each CVI student has a different way of processing information, vision factors would need to be taken into consideration, and realizing that changes with CVI over a child’s lifespan. The students health should be a consideration. The risks could be that the student is not getting the needed services to help them move forward. It would also mess with related services. Each CVI student being unique means that to mitigate these risks the team needs to be constantly assessing the changes or the stability of what is working. It might be as simple as noticing when it is taking longer or shorter to complete a visual task or what sounds can trigger. The team has to be in constant communication with each other and realize that each student with CVI is different, even though some things show similar. TSVI’s need to keep with with the current information on how CVI assessment is constantly changing.
I feel your pain - there is such a struggle in working with other professionals to understand that trial and error is a normal and required part of the problem-solving process with a student. I think the most challenging part is when the trial and error takes time, it’s hard to get others on-board with continuing to progress past a certain breakthrough, etc
I have to remind myself too. Children need choice and trust.
- Evaluate your system’s or region’s readiness to support students with CVI using the recommendations in this guide. What infrastructure (e.g., training, assessments, funding) exists, and where are the gaps?
Our school serves students both in residential and field service settings. We use LMA & FVA tools to consistently to track student progress. All of our students have IEP’s and a team of many practitioners committed to the students progress. We also have a Family-Infant-Team that provides in-home early intervention services to babies birth to 3 years old. I would say our school’s readiness to deploy the ECC is excellent… we integrate special 90-min classes at our campus and design 4 signature events around the ECC for students who are served in the field. The challenge of integrating some of the CVI interventions into daily routines is probably capacity… students in our residential program and served through field services have limited time. On campus, our TVI’s and SPED instructors are also tasked with teaching the core classes and integrating adaptions / modifying curriculum / and including ECC too. Our classes are mixed (High School is 9-12th grade in 1 class) and include students with and without CVI, so sometimes differentiating to that level is difficult.
Another struggle for our organization is in training. Taking this training online has been incredibly helpful and there are so many tools out there, BUT the time to dedicate to PD and training on this level of specialization is challenging to inform all staff: Teachers, Instructional Assistants, etc.
- Evaluate your system’s or region’s readiness to support students with CVI using the recommendations in this guide. What infrastructure (e.g., training, assessments, funding) exists, and where are the gaps?
It is fully up to TVIs to educate how to support students. I have found a readiness in working with OT, PT, SLP, DHH in co-teach/treat students and working on IEP goals together. This is not always looked at with favor. I have teachers who have told me that I should only be making my own goals, but the district started last year with teacher institutes where we are really hitting hard on inclusion. There are some good learning opportunities coming up this year and I have had a few administrators let me know they would help where we are having a hard time implementing inclusive practices. I think teachers are overwhelmed with working with students that need to have time given to them outside of what there schedule shows, but I am hoping to show teachers in classrooms and the aides in the classrooms to give choices. I think this will be a good starting point and quick and easy to implement while working with other students. Other students could answer or choose while a student with CVI is taking time to make the choice. Hopefully training will be embraced to help us all move in a direction that feels support for teachers and students.
I really love the emphasis on ECC, I would love that in my district. I know many of our teachers in district do not even know what the ECC is, but we have so many schools and some teachers have never had a student with a visual impairment so I think they are immediately overwhelmed with what to do with a student with a diagnosed VI. I have been working with administration to have something rolled into the beginning of the school year teacher institute to give some information for teachers to feel more confident and that we are here to support.
I appreciate your comment about the team needs to be in constant contact with each other. How does your district tackle this; email, meetings, in passing? I find it hard to meet with others unless I am working directly with them. I really want to have more communication with my students’ providers.
Many times it is in passing and emails. The OT and PT are contract so they message or stop by my classroom. The SLP will keep everyone updated. It is not always perfect, but we try.
I’ve seen the same thing. Many teachers are already stretched thin trying to meet the demands of curriculum and classroom management, so when they hear a student has a visual impairment, it can feel overwhelming. I’ve had to reassure staff that I’m not there to give them “more” to do, but to support both them and the student in ways that are manageable and meaningful.
What are the potential risks of applying interventions developed for one manifestation of CVI to another? How might these risks be mitigated?
CVI shows up in different ways for different kids, so what helps one child might confuse or overwhelm another. For example, a strategy designed for a child who has trouble seeing movement may not help a child who struggles to recognize faces or objects—and might even make things harder. If we don’t match the right supports to the child’s specific needs, it can lead to frustration, missed learning opportunities, and wasted time. To avoid this, it’s important to look closely at how each child uses their vision, involve a team of professionals and family members to create an individualized plan, and check regularly to make sure the support is working. Families need to be part of the process so that strategies can be used consistently both at school and at home.