Steps to Independence

Room 4 - M&I Policy and Service Room (Section 3 of 7) 

Section 3: Different agencies involved in M&I provision

Description of this section

Before the research was carried out, it was unclear precisely how mobility and independence education was provided for children with a visual impairment in mainstream education in the UK. The picture that has emerged from the research project is a very complex one, with several different ‘models’ of provision identified. This section aims to describe the different models of provision that were identified in the research, in particular focusing on the advantages and disadvantages of employing each model. The chief providers are as follows:

• Education service provision. The Mobility and Independence Educator (usually a Mobility Officer or Rehabilitation Officer, though sometimes a QTVI) who is employed directly by education has a lead role in the delivery of mobility and independence education to children.
• Social services provision. Mobility and Independence Educator(s) (predominantly Rehabilitation Officers) employed by social services who are either ‘bought in’ by an education service to provide mobility and independence support to children, or where social services include children as part of their remit.
• Voluntary organisation provision. Mobility and Independence Educator(s) employed by voluntary organisations (predominantly Rehabilitation Officers) are ‘bought in’ or contracted by education service (sometimes paid for jointly with social services) to provide mobility and independence education to children.
• Outside consultant provision. Mobility and Independence Educator is an independent (self-employed) ‘outside consultant’ or is a Mobility and Independence Educator bought in from another authority, agency or special school for vision impaired pupils by either the education service or social services, or jointly by education and social services.

However, the picture is somewhat more complex than this may suggest, since there is often further differentiation within each model. Within one authority a mixture of models may be implemented with different agencies being involved in different parts of the mobility and independence curriculum at different times.

Mobility officer employed by education

There were a number of examples of the education service directly employing a mobility officer to carry out some of its mobility and independence provision. Some of the key features, and some of the identified advantages and disadvantages of such an arrangement are summarised below.

Key features:

• Mobility Officers work exclusively on mobility and independence education with children (i.e. do not have additional work with adults).
• Mobility Officers are employed directly by the education service. This appeared to be the most common ‘model’ in our sample, but this may be more of a reflection of the sampling method used in the project rather than being the ‘norm’. The sampling method is described in the Methodology section of the full research report, Pavey et al 2002.
• The Mobility Officers employed by education have different job titles, including ‘Mobility Officer’, ‘Rehabilitation Officer’, ‘Teacher of Orientation & Mobility’, ‘Mobility Specialist in Education’, ‘Mobility Nursery Nurse’ and ‘Mobility Instructor’, which in some cases may reflect the individual’s past professional background, and their training. They also appeared to have a variety of qualifications – many not having the rehabilitation officer qualification.
• Sometimes this service was set up as no alternative or adequate service was available.
• There was also much variation in which aspects of the mobility and independence curriculum were covered.

Advantages:

• Many education respondents favoured having a Mobility Officer employed by the education service as they devoted all or most of their time to mobility and independence support with children, and were directly accountable to the service.
• They were more likely than other providers to work with all children regardless of any additional disabilities or the type of school they attended, though the Mobility Officer’s training had not necessarily prepared them for this.
• Many Mobility Officers felt being part of a multi-professional team (e.g. with QTVIs) was invaluable as each individual’s strengths and specialist knowledge could be shared and drawn upon.
• Such close collaboration made collaboration with mainstream staff easier also, i.e. where class teachers and teaching assistants reinforce mobility and independence programmes.

Disadvantages:

• Mobility Officers appear to be employed under a variety of contracts. Some work to a contract similar to that of a teacher where they are not required to work in school holidays. Therefore, school holiday provision was either on a voluntary basis or provided by a different agency. This may affect the amount of support offered to parents and family.
• Mobility Officers may feel isolated, as they may not work with any other Mobility Officer or Rehabilitation Officers (as would usually be the case in social services and voluntary organisations).

QTVI with additional mobility qualification

In some authorities mobility and independence education is provided by a Qualified Teacher of the vision Impaired who has an additional qualification in teaching mobility – this is in addition to other duties. Generally there seems to be one QTVI who is responsible for providing mobility and independence education in each education team, though in one authority there are two. In another service all the QTVIs have a mobility qualification and provide mobility and independence support to the children on their own teaching caseloads.

The following is a summary of some of the key features, and some of the identified advantages and disadvantages of such an arrangement.

Key features:

• The QTVI-Mobility and Independence Educator works exclusively with children.
• The QTVI-Mobility and Independence Educator is employed directly by the education service.
• Sometimes this method of provision was set up as no alternative or adequate service was available.
• The QTVI-Mobility and Independence Educator appeared to have a variety of qualifications, but all had a teaching and QTVI qualification. Some had an additional mobility and independence qualification in working with children and some had a generic Mobility or Rehabilitation Officer qualification.

Advantages:

Many education respondents favoured having a QTVI-Mobility and Independence Educator employed by the education service as:

• They were directly accountable to the service.
• They were more likely than other providers to work with all children regardless of any additional disabilities or the type of school they attend.
• There is likely to be a higher degree of contact with both parents and school staff due to their QTVI role.
• Mobility and independence is more likely to be represented, particularly in reviews about the child as the QTVI is more likely to attend these than other mobility and independence educators.
• Many parents are pleased that mobility and independence is dealt with by the QTVI as they already know them, and prefer to deal with one professional rather than several.
• Since the QTVI already works closely with school staff, those staff are more likely to become involved in reinforcing mobility and independence, and have a higher awareness of mobility and independence issues since the QTVI can include it in general awareness raising about all vision impairment issues.
• QTVI may have greater knowledge of other areas of the curriculum in which mobility and independence can be introduced and reinforced (e.g. PE, early years curriculum) compared with other Mobility and Independence Educators.
  The QTVI-Mobility and Independence Educator may be able to provide a more holistic approach in which mobility and independence is not considered in isolation.

The part time MO works with children in mainstream schools, whilst the QTVI who has an additional qualification in mobility carries out all mobility and independence support with children in special schools, as these children constitute her QTVI caseload anyway. HEREFORD

Disadvantages:

• Tend to work to a teacher’s contract, therefore school holiday provision was either on a voluntary basis, provided by a different agency, or not at all.
• After-school mobility may be neglected due to the QTVI’s contracted hours of work.
  QTVIs are relatively expensive to employ, thus allocating some of their time to mobility and independence work may not make the best economic sense.
• Concern was expressed (and examples given) that since mobility and independence is not the QTVI’s main role, it may not be a high priority when time is limited.

Mobility Officer / Rehabilitation Officer employed by social services

In many authorities surveyed, social services were the main provider of mobility and independence education to children, generally at the request of the education service, from which they would get the bulk of their referrals for children.

Key features:

• Often, social services seemed to be the main provider by default, i.e. it was the only agency available that could provide a mobility and independence service.
• Contracts seem to vary; in some cases, social services provision appeared to be provided free of charge, whilst in others social services provision is paid for by the education service.
• Written contracts were rare (though did exist) between education and social services detailing what mobility and independence support social services will provide, or how they will provide it.
• The mobility and independence educators in social services were usually trained as rehabilitation officers, and normally the majority of clients on their caseload were adults. One exception was found during the research:

The SSD-employed Mobility and Rehabilitation Officer works exclusively with children, and is funded and managed jointly by SSD and the education service. The post was created when both of the agencies became aware that there was a need for a specialist to work specifically with children. SALFORD

Advantages:

• Additional non-mobility and independence services are often provided, and they are likely to offer a more ‘holistic service’, considering not just mobility and independence issues but all aspects of the child's life, including advice to parents about benefits, additional communication support (braille, Moon, large print, etc), access to or advice on specialist equipment, and even counselling (e.g. CORNWALL, SALFORD).
• Social services rehabilitation officers are usually attached to a team, and therefore enjoy the benefits associated with team working, e.g. sharing experience and expertise.
• There is usually greater flexibility as to when the mobility and independence educator works, e.g. they work during school holidays.
• There is an easier transition for young people who leave school since social services will often be responsible for continued provision.

Disadvantages:

• Since there is rarely a contract or agreement between education and social services, it is often left to the discretion of the individual social services rehabilitation officer as to what mobility and independence skills they cover. Areas such as independent living skills are often not covered at all, despite the rehabilitation officer having had training in this area.
• In some authorities the social services team was essentially an adult services team, therefore children were not really part of their normal remit.
• There are examples of under-resourced social services departments, and children being placed on waiting lists for mobility and independence support.
• Often the training and past professional experience of social services rehabilitation officers would not have been child-focused. Social services rehabilitation officers may not therefore cover many of the essential foundation skills children need, such as concept development, free movement and confidence building.
• There also appears to be a lack of training and experience amongst social services rehabilitation officers in working with children who have MDVI, and few work with children in special schools.
• Some Heads of Services in education were unhappy that they had no control or influence over the content and the way mobility and independence education was provided by social services.
• Several respondents expressed a desire for provision from a different agency or professional, for example somebody either attached to or responsible to the education team. Not all felt this way however; one respondent believed that the education service did not need to oversee the service provided by social services.
  Provision by social services was often reported to be fragmented, lacking a developmental approach.

Mobility officer / rehabilitation officer employed by a voluntary organisation

Many different voluntary organisations are involved in providing mobility and independence education around the country. As well as national organisations such as Guide Dogs there are many local societies involved in different authorities.

Key features:

• Voluntary organisations usually employ Rehabilitation Officers who carry out the majority of mobility and independence work with children.
• Historically voluntary organisations were often the only agency available that could supply a mobility and independence service.
• Contracts between agencies vary widely from one authority to another, in terms of the services provided as part of the agreement. Most cover travel skills both within and outside of school, but independent living skills are not always covered. For example:

In one county, the local voluntary organisation is contracted by SSD to provide all services for clients who are visually impaired (adults and children) that would normally be the remit of social services, providing continuity in support for children and their families.

In another county, the voluntary organisation service level agreement is very broad, seemingly covering the remit of health, education and SSD. Their services include guides, communicators, day care, LVAs, follow-up clinics, and rehabilitation services. The voluntary organisation also has information officers based in the hospitals as part of the agreement.

The contract offered by the voluntary organisation was originally based upon a tight definition of ‘mobility’ defined as ‘travel’, which would not be appropriate for the authority’s many children with MDVI, many of whom are educated in mainstream. Therefore the contract was re-negotiated to include some independent living skills which were directly related to travel activities (e.g. shopping, putting coat on, etc., but not cooking) and LVAs.

• Many of the Mobility and Independence Educators employed by voluntary organisations appear to be trained as Rehabilitation Officers. The majority work with adults as well as with children, and rarely specialise in working solely with children.
• It seems to vary between authorities as to whether the mobility and independence educator works with children in both mainstream and special school settings, but in practice they often do.

Advantages:

• The voluntary organisation may be more accountable to education than social services since they are more likely to be paid for the service, and have agreed contracts.
• An incidental advantage of provision from a voluntary organisation is that they often have a broader (and substantial) support service beyond the contracted work. Therefore the child can tap into this network, such as the time and resources of any volunteers in the organisation and the use of the voluntary organisation’s resource centre. Another benefit that children may enjoy in some authority areas, are holiday schemes and activities which are organised and run by the voluntary organisation, for example:

The voluntary organisation introduced a team concept of mobility. In schools where there were several children with visual impairment who were not mixing with other children at break times, the voluntary organisation created an activity period, an “extension of mobility” – this included football, cricket, tag with people calling directions, rolling a ball with bells inside. From this a Goalball team for the city emerged. LEICESTERSHIRE / LEICESTER CITY

• Since voluntary organisation employees usually work year-round, there is also the benefit of more flexible working, particularly during summer holidays.
• Many voluntary organisations have a team of visual impairment specialists and/or Mobility and Independence Educators, so the expertise and assistance of several members can be drawn upon.

Disadvantages:

• When any ‘third party’ is involved in providing mobility and independence support, there is again a question over the degree of control that the education service has over the process, when the Mobility and Independence Educator is not directly accountable to education.

Outside consultant Mobility Officer / Rehabilitation Officer

Several authorities have ‘bought in’ the services of either an independent (self-employed) Mobility and Independence Educator or a Mobility and Independence Educator employed by another education authority, agency or special school for visually impaired pupils at some point. The key features, advantages and disadvantages of such an arrangement depend on the circumstances relating to a particular authority, and therefore cannot be easily generalised.

Key features:

• Often they were contracted in on a temporary basis until more permanent provision could be established, or on a one-off basis to assist in areas that the main provider lacked expertise in, e.g. deafblind issues, PE.
• In one authority an independent consultant Mobility and Independence Educator was contracted to provide ongoing mobility and independence support for all children within the authority area.
• The background, training and experience of consultants will vary, and this may affect the type and age of children they are able and contracted to work with.

Advantages:

• The mobility and independence educator is directly accountable to the service by which it has been contracted in, and can work closely with the education service and QTVIs at all stages of the delivery cycle.
• The mobility and independence educator can be more flexible regarding working hours, carrying out lessons before and after school if applicable, and even occasionally on weekends and during school holidays if requested.

The self-employed contracted-in mobility and independence educator is directly accountable to the education service, and works closely with the education service and QTVIs at all stages of the delivery cycle. The mobility and independence educator can be more flexible regarding working hours, carrying out lessons before and after school if applicable, and even occasionally on weekends and during school holidays if requested. COVENTRY

Disadvantages:

• In one authority, there has been no continuity since the services of several outside consultants have been used, because there is a high turnover of professionals in the authority.
• Examples were given of contracted mobility and independence educators who felt that they did not have enough time to provide a comprehensive service. For example they felt they could not adequately prepare for lessons or compile reports, and may not have as much contact with parents or attend important annual reviews or other meetings about the child.

Multi-agency provision – issues to consider

As previously discussed, in many authorities there is often more than one agency involved in the provision of mobility and independence support. One agency may well be the main provider, whilst another agency is involved in the delivery of particular aspects of the mobility and independence curriculum, e.g. independent living skills. Alternatively responsibilities may be divided according to the area of mobility and independence education, e.g. in and around school mobility and independence and out of school or home area mobility and independence.

Other examples might be where the QTVI does mobility and independence work with children with MDVI as it is their specialist area, or where the QTVI has the pre-school caseload. Often, provision of mobility and independence education during school holidays is provided by a different agency (usually social services) if the main provider (particularly if employed by education) is not contracted to work during school holidays.

Whether such sharing of responsibility works depends on several factors, including the effectiveness of communication between agencies.

When more than one agency or professional is involved with a child, difficulties can arise. First, it can be confusing for the family to know who to approach if more than one professional is in contact with them, particularly if the professionals are also from different agencies. There needs to be a clear point of contact for parents to use, ideally a professional who co-ordinates the services provided by different agencies.

Secondly, there needs to be co-ordination regarding the parts of the mobility and independence curriculum being taught, and consistency in how they are taught.

The research found that communication between different professionals who were based together or employed by the same agency was often very effective. Other cases where good communication took place were when the Mobility and Independence Educator had trained with Mobility and Independence Educators from the other agency or had worked for that agency in the past. This suggests that a problem with inter-agency communication in some authorities is that professionals from different agencies may not understand the philosophy (aims and modus operandi) adopted by other agencies.

Several factors and practices that appear to aid the process are demonstrated in the following examples, where there was effective communication:

In order to ensure effective communication between the agencies involved in providing M&I education, social services and the education service have regular joint meetings where issues can be discussed, and keep in regular contact by telephone. CAMBRIDGESHIRE, NORTH YORKSHIRE

The social services Rehabilitation Officer often accompanies the QTVI-Mobility and Independence Educator on lessons so they are aware of what the child is taught and the methods used to ensure continuity in holiday provision. NORTH YORKSHIRE

The Mobility and Independence Educator teaches the same cane technique with children in holidays as the technique taught by the Mobility and Independence Educator in the special school for visually impaired pupils that they attend in term time. The MIE then writes a report for the special school’s Mobility and Independence Educator who is then aware of what has been done with the child. COVENTRY

In one authority, there has been a general move towards strategic working between health, social services, education and voluntary organisations resulting from a government initiative regarding funding for visual impairment services. TAMESIDE

The following is an illustrative example of effective liaison between professionals:

Assessment by the education Mobility Nursery Nurse (MNN) is often carried out in conjunction with the social services RO so that they can share ideas about programmes. The MNN continually informs social services of the child’s progress. The education MNN works predominantly in the school environment during school time as she is based in education and this fits in with the part-time hours she works. Whereas the social services RO works with the child during holidays and before/after school, in the home area or on routes to/from school. ROTHERHAM

Where there appears to be a strategic view of mobility and independence support, there seems to be successful collaboration between (and within) agencies and all that goes with it (e.g. sharing of files, consultation on programme design).

Activity 3

Think about the local authority in which you are working, and the various agencies located within it.

What expertise is available in M&I education (particularly with children) and how could this be drawn upon?

Were there particular aspects of the M&I curriculum that are not adequately covered at present, and if so, how could other professionals help in this?

Where two or more agencies are involved with a child, how do they work together? What are the strengths and weaknesses of any joint working initiatives? How could such initiatives be improved? 

Recommendations based upon good practice

For many authorities the ideal model is to have one (or more) Mobility and Independence Educator (usually a Mobility Officer or Rehabilitation Officer) employed by the education service. If the model is implemented correctly, the Mobility and Independence Educator is managed as part of a broader educational team, and this enables successful collaboration within the visual impairment service and with school and home.

However, when proposing the ideal model of provision for a particular authority, several factors have to be taken into consideration, including:

• The number of children with a vision impairment in the authority and any additional needs they may have.
• The geographical size and location of the authority.
• The presence of a voluntary organisation or social services department in the authority area that is equipped to provide a suitable mobility and independence service to children.

These considerations are discussed in section 5 of this room, ‘Developing / managing an M&I service’

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