נWritten by Prof. Kenneth Caslo, the professional director of Elia
In order to better understand the optimal intervention methods for the advancement of infants and children with blindness and visual impairment, in ELI we conducted a review of the various intervention approaches available in different countries around the world. This document is a summary of our review. But it faithfully represents the various strategies and approaches that exist in the field.
Treatment in the United States is governed by a law passed in 1970 and amended several times since then (in 1980 and 2004), called IDEA (The Individuals with Disabilities Education Act). Originally, the law was intended to provide children with disabilities with school-age ‘adequate and free public education’,In ‘environment limits as little as possible’. In the 1980s, the law was expanded to offer federal grants for special education services for children from birth to age 3.
Early care services are voluntary for eligible parents, whose eligibility is determined by each state. The natural environment is determined so that the child will be in it if he or she did not have a disability (home, daycare, kindergarten), under Part C, which covers toddlers from birth to two years. Children from the age of 3 to the age of 21 are covered under Part B, which is broader.
- Appropriate and free public education.
- Environment limits as little as possible – if possible – a regular class, if not – a special education class in a regular school, and if not – a special education school. This division is determined by each child’s personal education program (IEP).
- Full and individual evaluation (FIE):
- Eye examination by an eye professional.
- Functional vision assessment to diagnose how the child is using the vision he has
- Orientation and mobility assessment.
- Personal Education Program (IEP).
- Parental weighting in educational decisions.
- Enforcement to ensure that relevant local authorities exercise the child’s right to adequate and free education.
This law is the basic structure that determines the specific intervention for each country. Each country has a slightly different policy on how it implements the law. In the age group 6 months to 3 years, in Florida there is a model similar to the one that exists in Israel, ie a kindergarten and daycare program with public support (in parallel with private frameworks). In South Florida, this plan is provided by Florida Heiken Children’s Vision Program of the Miami Lighthouse for the Blind.The children spend most of the day in this facility, in parallel with home care for those who are unable to reach. In New York, Massachusetts, California and Texas the system is based primarily on homeschooling, with daily / weekly visits of children and parents to learning centers. There are also state programs, like in Texas for example, where it is called the Early Child Intervention Service. The services provided are as follows:
The Early Childhood Care System, from birth to 3 years old, is a state-funded state program under the IDEA Act, Part C. In Texas, this program (called ECI) is under state health services.
This program works in conjunction with a variety of local organizations and agencies throughout Texas to provide services to a toddler in his or her “natural environment,” typically at home, in a nursery or as part of the Mother’s Day Out program. The professionals work together with the families to promote development and learning, provide support, coordinate services and reduce the need for special and expensive programs.
Once the child is two years old, the program staff begins working together with the families to determine the best pre-school program for the child, and to ensure a smooth transition to the school system. During this period, called ‘transition’,The team works with families to develop a transition plan that will be part of the child’s IFSP program (Individual Family Service Plan). The children ‘finish’ and leave the ECI after they are 3.
At age 3, families can choose from a number of optional compulsory kindergartens. One option is a private garden, and another option could be PPCD. PPCD is a compulsory kindergarten program for children with disabilities, ages 3-5, available through the public school.
Many universities in the United States offer undergraduate and graduate degrees in the various aspects of early treatment of the visually impaired.
In Hungary, the only treatment option is in designated centers. There are no regional centers for the early treatment of visually impaired children in Hungary. Existing services are provided from birth to age 4. Hungary supervises early treatment under the Education Act, meaning that the provision of their services and funding is the responsibility of the Ministry of Education. The early care center is funded by the state (70% of its budget) and serves 87 families through 2 full-time and 5 part-time employees (as of 2006). The ratio of children to teachers is 20 children per teacher. Twice a week.Some universities offer early treatment training courses.Although there are no special treatments designed for the early treatment of children with visual impairments, But the center uses many methods and approaches to treatment, correction and developmental encouragement. These include hydrotherapy, movement therapy, physiotherapy, music therapy and more. The center’s staff includes specialists such as therapists, psychologists and ophthalmologists / optometrists.
In Austria there is one public institution and two private institutions. Although there is no national legislation in the field, in each of the 9 districts of the country there is its own legislation within the framework of welfare and health services. The services are available from birth to age 7. Both private institutions focus mainly on home-based care, while the public provides mainly center-based services in small groups. In Austria there are 3 different types of treatments. A 2006 survey found that:
In Tyrol, the organization serves 54 families with 7 part-time and full-time caregivers. One full-time caregiver cares for 10 children. In Salzburg and the surrounding area, one full-time caregiver was reported working with 10 families, along with 4 teachers – one full-time and 3 part-time. The frequency of home visits ranges from one to a week or two. In Upper Austria and in Linz, the center provides services to 90 families, with 4 caregivers – one full-time and the rest part-time. A full-time employee serves 30 families once a week, fortnightly or a month – depending on the specific need of the family.
In the Czech Republic, the country covers only 50% of the budget of institutions serving children with visual impairments. The laws governing the care required are under the Ministry of Welfare. The main focus is on providing support to the family (parents) and the covered ages are birth to age 6. The main care provided is home-based care. Tests and assessments are given at early treatment centers, as well as various family programs (weekends, vacations, etc.). The basic treatment provided is low-vision therapy, plus physical therapy.
The number of families treated in the Czech Republic stands at 500, and 47 caregivers represent a ratio of 1:10. But many of the caregivers work part-time, so the ratio stands at 25 families per full-time teacher. The frequency of visits ranges from one visit to a month or two. Therapist training is done through courses in treatment centers, rather than through academic training programs.
The legislation regulating the treatment of the visually impaired is under the Ministry of Health and the Ministry of Education. The age range covered is birth to age 6, and the programs are funded by the government. The programs are home and center, and the Polish Academy of Special Education is responsible for performing assessments and tests. The various centers offer a wide range of treatments (vision, music, hydrotherapy, movement, etc.). / p>
A survey conducted among 3 leading institutions found this – in Warsaw, the Keshet Foundation serves 120 families through 6 full-time teachers and 3 part-time teachers, with a 25/1 ratio. The frequency of visits depends on the area where the family lives. If the family lives in Warsaw, the visit is made once every two weeks, and out of town once a month. The early care team at the Academy in Warsaw provides service to 30 families, with one full-time teacher and 3 part-time teachers, In a ratio of 15 children to a teacher. The visit is made once a month. The third organization surveyed serves 155 children and families through a team of 5 teachers, all full-time, at a ratio of 30 children per teacher with a frequency of weekly visits. In 2 centers examined, the staff includes teachers, psychologists, ophthalmologists / optometrists and neurologists. Poland offers training both through universities and treatment centers.
In Australia, early treatment programs operate as part of a comprehensive program called Vision Australia. In 2004, this program became the first national agency to treat blindness, following the merger of several agencies. And in 2006 and 2007 even expanded with the addition of more organizations.
In July 2008, Seeing Eye Dog Australia also joined the agency, and is currently the only one in the country to provide guide dog services. Vision Australia is a comprehensive program that covers children from birth to their first steps, starting school, finding a job and most of adulthood. In collaboration with the parents, the team develops strategies that are appropriate to the child’s needs. The support network includes diverse professionals, including communication clinicians, physiotherapists, occupational therapists, psychologists, movement and orientation specialists, technology accessibility specialists, orthopedists and teachers who specialize in child development.
There are a variety of funding sources for families in need of program services-MedicareAnd a national insurance framework for people with disabilities. The program currently supports more than 2,100 children (and a total of 25,000 people) nationwide. Funding for the program comes from government and private donations.
In England there is a professional organization (VIEW) representing the sector working with children with visual impairments. According to this organization, there are a number of key issues regarding the care of children with visual impairments in the country.
In recent years, the organization has watched with concern how a combination of budget cuts, changes in funding and teaching countries is leading to a crisis in the care of visually impaired children. This crisis is causing real damage to the care of this population, in a way that could impair their ability to become independent adults in the future.
In England there are about 25,000 blind or visually impaired children, ie 2 children and young people up to the age of 25 per 1000 people (0.2%), not including children with ‘mild’ visual impairments. Some of these children face additional difficulties that affect their ability to learn and develop,Especially a combination with disabilities and other limitations, for example eye movement problems, or a disorder in the way the brain interprets visual information. There is a higher incidence (10.5%) of visual impairments among children with disabilities. In the population of children with learning difficulties, the estimated prevalence is 5.6%, with the risk of visual impairment increasing with the increase in the severity of learning difficulties.
Although childhood visual impairment is often included along with hearing impairment as a sensory disorder, early severe visual impairment is primarily considered as a severe neurodevelopmental disorder,Given its impact on many different developmental processes. The nature and quality of treatment for visual disturbances in England and the UK vary greatly between different places and different descriptions.
Infants and young children with visual impairments need professional assistance as early as possible after diagnosis – support that is usually provided by a teacher who specializes in teaching children and young people with visual impairments. Many studies emphasize the importance of early intervention by a professional to ensure optimal developmental and visual progress. Despite the vast evidence regarding the importance of early intervention, there is still a significant delay in referring some toddlers and children for professional care..
- בAnother 86% of local authorities have a clear arrangement for referring infants and children to visually impaired care services, there are still authorities without clear referral arrangements.
- Even when there is a local referral arrangement, the referral is still delayed for various reasons:
- The child is not treated in a local hospital, but in a hospital where there is no arrangement with the care services of the local authority in which he resides, or in a hospital specializing in another area. Eye Clinic Liaison officers at these centers reported difficulty in obtaining contact information at visually impaired outpatient care services. Although this information is supposed to be on the Local Offer page of the local network, in many cases it is permissible to find, or includes only details of generic early treatment services.
- If the child is being treated by an ophthalmologist who usually treats adults, or by a pediatrician who is not an ophthalmologist, the same doctor may be unaware of the need to refer the child to the relevant treatment services.
- In addition to the above regarding delay in referral, anecdotal evidence suggests that there is a tendency in some places to refer infants and young children with visual impairments to generic ‘milk drop’ services, rather than to services for the treatment of visual impairments.
To address these issues, the following steps have been suggested:
- Recognize and allocate the funding needed for intensive and professional interventions and treatments for all toddlers and young children with visual impairments.
- Recognize that visual impairment is a lifelong limitation, and that proactive support from professionals is essential throughout childhood and early adulthood. It is not to be assumed that support is required only in response to a specific difficulty and for the sake of progress in a short range of academic outcomes.
- The important role of professional teachers with relevant knowledge (QTVI) and qualified rehabilitation experts should be recognized and the appropriate quality and quantity of these professionals should be maintained through funded training and continuous professional development.
The main organization for early treatment in Ireland is called ChildVision (formerly known as the St. Joseph Center for the Visually Impaired), an organization that has been operating for almost 150 years. It is estimated that there are approximately 224,000 blind or visually impaired people in Ireland,Of these, about 1.8% (about 4,000) are children. ChildVision is the only place in Ireland dedicated entirely to the educational and therapeutic needs of blind and visually impaired children. The organization cares for children from all over Ireland from birth to 23. The group of caregivers includes communication and language clinicians, teachers, nurses, Braille teachers, social workers and more, as well as housekeeping and maintenance staff.
The campus includes a kindergarten, a treatment center, an education center, the national assessment service, an eye and low vision clinic, a living area, a horse farm and a swimming pool. All services are offered free of charge and the funding comes from a combination of public and private resources, and mainly from three main sources – the Health Services Authority, the Ministry of Education and various corporations and funds, along with public and private donations. The organization has kindergartens in the cities of Dublin and Cork, which include the full support of medical staff. The children arrive at the kindergarten between one and five days a week (via a dedicated shuttle that is also suitable for wheelchairs) from the morning until the early afternoon
It is estimated that there are about 70,000 school-age blind children in China, most of whom live in rural and agricultural areas. The schools that offer a special educational framework for the visually impaired are mainly in the big cities, which are sometimes thousands of miles away from the villages. All facilities are state-funded, and almost all treatment options are center-based, with some of them also available at the child’s home.
The change of Russian society is reflected in various areas of the socio-medical world, including the system of treatment and identification of developmental disorders in children. An important step in creating a framework for early treatment was the idea of creating an early treatment system for children with disabilities that was promoted by the Russian Ministry of Education in the mid-1990s. This idea included both improving the quality of care provided and providing medical and psycho-pedagogical services to Early Childhood Development.
The leading staff of the Institute of Remedial Pedagogy in Russia has developed the national framework for the early treatment of children with developmental problems. The main tasks of this system are defined by:
- The earliest identification of special educational needs of children.
- Maximum reduction of the gap between the definition of the disorder and the start of targeted treatment, including non-specific and specific components.
- Mandatory inclusion of parents in the learning process, starting in the first years of a child’s life.
- Extending the time limits for special education, when the low threshold is the first months of the child’s life.
- Existence of a special education standard, which defines academic achievement along with level of ability.
- More oriented and gradual education, which in most cases is not required in the educational framework of a child in normal development.
- Customization of the learning process and special organization of the learning environment.
Early treatment services were opened as a built-in unit within:
- Integrated kindergartens and kindergartens.
- Special education schools facility.
- Various learning centers – diagnosis and counseling, psychological, medical and social support, pedagogical-psychological rehabilitation, remedial teaching and others.
The purpose of early assistance services is to provide psycho-pedagogical and socio-medical support to families with toddlers with developmental problems.
הThe Institute of Remedial Teaching of the Russian Ministry of Education has created a uniform national program for early detection and special assistance for children with developmental disorders (starting in the first months of life). Today, a variety of support services are offered to families with young children suffering from various disorders. The initial model was created in Novgorod, where there is extensive experience in treating families in Moscow (where there are several institutes at the national level), in St. Petersburg (non-national institute), Samara and Rostov, where an early diagnosis and treatment plan was adopted from provincial budgetary sources. Other cities in Russia (e.g. in the Moscow region) adopt their own models for rehabilitative assistance to children with children Disabilities. Professionals working in public organizations are trying to solve the problem of helping children with developmental disabilities and their families, and for example centers in the cities of Nizhny Novgorod and Saratov have opened centers for the early treatment of children with visual impairments.
In Nizhny Novgorod, a group to help visually impaired children was opened as part of the Center for Early Treatment, a group created by members of Perspective, a public organization that unites parents of visually impaired children. Educational activities for children are delivered by communication clinicians, instructors Physical training, musical director and more and the work is done in close contact with the parents.
בSaratov, the early assistance for children with visual impairments began in 2004 as part of the organization ‘Center for Rehabilitation and Assistance for Children with Visually Impaired’. Unlike their counterparts in Nizhny Novgorod, professionals in Saratov have developed and tested innovative technology for early treatment through home visits of children with severe visual impairment and their families. In 2012-2013, the technology they developed was implemented in the field, and operated as part of a national pilot. As of 2014, assistance for children with visual impairments is provided in 2 forms – home counseling (for children up to the age of 3) and a kindergarten group (for children aged 2 to three). Children aged 3 are enrolled in a kindergarten group, which operates within the school and thus has an educational continuum For the children. Students in the Faculty of Special Education and Psychology at Saratov University are integrated into home care as volunteers. Students in special education teaching and psychology learn to develop personal study paths, conduct research dealing with cognitive and emotional activity among children and acquire practical skills in working with the blind and visually impaired, including children with additional disabilities.
In Japan, there are about 300,000 visually impaired people, out of about 2,000,000 people with disabilities. The country has successfully developed an educational methodology to support the blind in existing schools in agricultural areas, through the addition of a teacher serving 8-10 neighboring schools in a particular area.
In Japan, there are 65 special schools for visually impaired students, and 171 children are in the kindergartens of these schools. Half of them also frequently visit a regular kindergarten or nursery. Special schools for visually impaired schools are also common. Because the state considers the principle of integration important, many visually impaired children attend both special and regular schools.
The University of Teskova has the only national school for the visually impaired in the country. The tasks of the school are:
- To provide the special assistance needed for toddlers, children and students with visual impairments, as well as to provide general education in the kindergarten, school and high school system, combined with professional remedial teaching.
- Collaborate with the university in the field of research and integrate students into the school’s practice.
- Continue to develop expertise in education for the visually impaired in research and daily practice and share findings across the country.
- Provide essential educational support for toddlers and visually impaired students who are not enrolled in school.
- Assist in the creation of textbooks for toddlers and visually impaired students and collaborate on other activities in the field of teaching the visually impaired in Japan – for example in the creation of textbooks and other teaching materials. Also, implement Braille entrance exams in writing to assist visually impaired students.
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- Kindergartens and elementary schools
We accept a variety of students, including those who require special assistance. We enhance the learning experience through flexible teaching methods, such as unique lessons and personal tutoring, tailored to the child’s developmental stage.
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