Room 3 - Delivery Room (Section 3 of 12)
Section 3 – Assessment
Description of the assessment process
There are essentially three separate strands to assessment, namely the initial assessment of the child following referral, ongoing assessment of the child (discussed later in section on ‘Review’), and assessment of the environment and context the child must operate in. In this section we are concerned with the initial assessment of the child, and environmental assessments.
Initial assessment
Activity 8
Prior to reading on, you should first consider why an initial assessment is considered to be important before designing a programme for a child.
You should then note down at least three areas the initial assessment should cover. You can then compare your list with those areas identified within the M&I research project.
The initial assessment is considered to be important as it assesses not only the child’s current level of mobility and independence, but also important additional factors which should be taken into consideration when determining needs. Each child’s individual circumstances and personality traits need to be considered at all times, including:
- The type and degree of visual impairment, and any other disabilities or difficulties they have which may affect their mobility and independence
- Their ability to transfer skills and problem solve, particularly in the case of children with MDVI
- Their personality, including their level of confidence, self-motivation and self-esteem, whether shy or outgoing, and their attitude to mobility and independence
- Their age – many participants in the research project reported that an aim for most children in mainstream is for them to be on a par with their peers
- The environment in which they are operating (e.g. crowded playground, dark school corridor, etc)
A broad recommendation is that any initial assessment should be ‘holistic’ in nature, and go beyond the direct reasons for the referral. This is important since identified difficulties may be due to other difficulties the child experiences, or reinforced by them, and it may not be obvious why the child is having difficulty without considering the ‘whole picture’. An initial assessment should cover the broad mobility and independence curriculum, as well as other factors:
- Early and foundation mobility and independence including body and spatial awareness and social and emotional development.
- Advanced mobility and independence including travel skills and independent living skills.
Low vision assessment (when relevant.)
- Expectations of the child.
Context – family and school support, and environment.
Some examples of this practice include:
When carrying out an assessment, the Mobility Nursery Nurse always assesses the child’s understanding of body image and spatial relationships, regardless of the age of the child, to make sure these ‘foundations’ are in place. ROTHERHAM
Many services carry out a holistic assessment of the child, covering all aspects of mobility and independence (e.g. independent living skills) irrespective of the reasons for the referral, to ensure that any other mobility and independence needs are identified and addressed earlier. NEWHAM, CORNWALL, LEICESTERSHIRE, TAMESIDE
Importantly, the assessment should draw upon information available from other sources, in order to ensure that the same assessment or area of assessment is not carried out more than once, particularly if different agencies are involved with the child. Therefore, the assessment may require a team approach.
An assessment should draw upon information available from other sources, in order to ensure that the same assessment or area of assessment is not carried out more than once. Whether or not a full assessment is undertaken often depends on the amount of information the RO already has about the child. HAVERING
Where social services or voluntary organisations are involved, the initial assessment covers an even broader remit than mobility and independence, including ‘social’ needs. Social needs might include state benefits and allowances, counselling, leisure activities, and communication needs (e.g. telephone, reading, writing, cassette recorder, typing/computer, Braille and Moon). Where different agencies are involved there needs to be an understanding about what aspects each agency is responsible for, and any information collected about the child should be shared to ensure a seamless service for the child and family.
The following is an example identified in the research where this happens:
The outside consultant MO contracted in by education sometimes picks up on non-mobility issues and informs the appropriate agency, e.g. social services. COVENTRY
How assessments are carried out
The assessment may require a series of sessions, but ideally will have the following features:
- A session at the child’s home; this is also an opportunity to develop good relations with the family
- A session at the child’s school; this also enables an opportunity to get class teachers and teaching assistants on board for aspects of delivery of a mobility and independence programme
- If possible, a session in the situation where the child was experiencing identified problems (e.g. in the playground, at lunch time when crowded).
- In addition, assessments should take account of day-to-day changes in the child’s performance, and the changing conditions in the environment (e.g. lighting).
The assessment should be carried out in both familiar and unfamiliar surroundings.
Examples from the research where initial assessments consist of several sessions, each varying in length include:
The Co-ordinator for Mobility and Rehab Services carries out four sessions on average. The first may be short, to get to know the child. The second might involve work around their school. In the third, they may venture out into the local school area. In the fourth, they may go to a busier, unfamiliar area. NEWHAM
The assessment could involve one session, or up to three – it depends on the age and ability of the child. A young child may become anxious in a long session. BIRMINGHAM
A variety of people should be involved in carrying out assessments. Key people include:
- Parents.
- QTVI.
- Class teacher(s).
- Teaching assistant(s).
The key contact depends on the provider of M&I education, for example social services respondents seem to lean towards the family, whilst many respondents employed by education are more school-focused, reflecting the roles and natural working environments of each agency. In some cases the focus depends on the age of the child, for example:
The MO visits parents jointly with a QTVI if the child is young in order to get to know the parents and give them support, but assesses in the school with teachers’ input when the child is older. DERBY CITY
Contacts with both school staff and family are important as both spend a considerable amount of time with the child and both have information that needs to be shared with the mobility and independence educator as part of an assessment. It is also important for the mobility and independence educator to take into account the expectations and attitudes of both school staff and the family as these will affect the child. The mobility and independence educator may also note their capabilities for supporting intervention, if necessary.
Activity 9
Before reading on, you should note down at least three ways in which you currently collect data during an initial assessment of a child, if you are involved in them. You can then compare your list with the range of ways identified within the research project.
A variety of methods of data collection should be used as part of an assessment. These include:
- Observations of the child (in various contexts as described above).
- Discussions with key people (described above).
- Discussion with the child to find out their expectations and what they want to be able to do.
- Use of games, and relevant tasks according to the age of the child.
- Reports available from elsewhere.
- The use of a checklist of mobility and independence skills.
Examples from the research of how assessments are carried out include the following:
The Mobility Officer uses games to assess a child, e.g. throw/catch, and visual tasks and basic ILS tasks, e.g. identifying products in shops, getting children to tie their shoe laces as an indicator of ability to carry out other dressing skills. NEWHAM
It is important to assess any functional vision the child has and if they use it, though this is difficult to assess (as many sessions are needed). The MO assesses by taking the child to unfamiliar areas and asking what they can see, and watching how they negotiate people and objects. RHONDDA-CYNON-TAFF
The use of checklists as a method of recording a child’s progress is recommended. Examples include:
- Published checklists, e.g. Pathways to Independence (LNCVCD, no date), Cratty and Sams’ Body Awareness (1968), TAPS: Teaching Age-Appropriate Purposeful Skills (Pogrund et al, 1995), Oregon gross motor skills (Brown et al, 1991), often aimed at particular groups of children, e.g. pre-school.
- Checklists constructed by individual services or professionals (often compiled with sections from above published checklists).
- Checklists borrowed from other services / MISE curriculum group.
The following are examples where checklists with broad mobility and independence remits are used:
The service is carrying out a pilot project using a document jointly produced by education and the voluntary organisation providing mobility support, to holistically assess children. It covers a range of skills including independent living skills. LEICESTER
The education service uses a checklist broken down into key stages, with a progression relating to age though this is applied differently to each child since it is vital to consider the individual nature of each child. NORTH YORKSHIRE
Environmental assessment
Environmental assessments are necessary to ensure that environments are as safe and accessible as possible for the child. Since children who are visually impaired are not homogeneous in terms of their visual impairment, each assessment has to be done considering the individual requirements of the child concerned. As more children are being educated in mainstream settings, requests for environmental or ‘risk’ assessments are increasing.
Activity 10
Before reading further about environmental assessments, you should reflect upon when an environmental assessment is carried out in your service or a service known to you. Is it for example, on request by the schools, parents or others, or automatically at key points in a child’s education (e.g. at points of transition)?
You should then note down at least three types of ‘recommendations’ which might arise from an environmental assessment. You can then compare your list with those presented later in this section.
Type of environment and outcomes
Environmental assessments tend to be of school premises, particularly at the point of transition from one school to another, and are often requested by the school that may be concerned about offering a place to a child. Assessments were occasionally of other environments, as the following example from the research demonstrates:
A combined group of children with visual impairment and children with hearing impairment were going on a (mainstream) school trip to a nature reserve, and the MO was requested to carry out a risk assessment, looking at footpaths, stairs, steps, etc. The exercise was very valuable as the trip went ahead without problems. ROCHDALE
Often, environmental assessments are an important part of mobility and independence support for pre-school children and their families, either in the child’s home or in a nursery:
A lot of pre-school mobility is about working with parents and teachers (in a nursery) to advise them on how to create the best environment for the child. TOWER HAMLETS
The outcome of an environmental assessment is normally a series of recommendations for making adaptations to the environment which require funding, or general advice on how the environment can be made safer, more accessible, or to maximise independent use of equipment.
Recommendations might include the following, depending on the individual needs of the child:
- Advice on simple ‘housekeeping’, e.g. staff and pupils to keep thoroughfares tidy and free of obstacles
- Advice on organising common areas, e.g. canteen areas
- Advice on lighting, e.g. avoiding dark corridors for children with low vision
- Colour contrasting, e.g. doorways contrasting with walls.
- Highlighting potential hazards, e.g. painting the edge of steps white or other bright colour
- Fitting blinds to windows for children who are affected by bright light
- Making sure a child’s desk does not face a window without a blind if they are affected by bright light
- Installing handrails on all stairways
- General enhancement of the learning environment to encourage independent movement and use of equipment.
Responsibility for environmental assessments
A mobility officer or rehabilitation officer predominantly carries out environmental assessments. The other key professional responsible is the QTVI, particularly in areas where there is not a mobility officer employed directly by the education service.
Recommendations based upon good practice
Assessments can take a number of forms and specific recommendations regarding the form they should take are presented below. However, all assessments should identify clear action points and associated responsibilities. Copies should be held by the school, parents, and the service.
Initial assessment
- Initial assessments should be holistic in nature covering the broad mobility and independence curriculum.
- If more than one agency or professional is involved with the child, procedures for co-ordination and collaboration should be in place.
- Assessment must be carried out in relevant locations (e.g. home, school, both familiar and unfamiliar), and involve people who are closely involved with the child.
- A variety of methods should be used, including observation, discussion with the child and key people, use of games and relevant tasks, as well as consulting records and reports about the child.
- Formal record keeping methods should be used (e.g. checklists).
Environmental assessment
- For pre-school children, the environmental assessment must include the home environment, to provide parents with advice on safety and fostering independence.
- An environmental assessment should take place before school entry and at times of transition.
- Minimum levels of adaptation should be specified.
Activity 11
Think about a service that you are involved in or that is known to you; think about the assessment process and compare it with the recommendations presented above.
In relation to assessments of the child:
- Think about the people who are involved in carrying out an assessment following a referral. Are there others who could usefully be involved?
- Is the assessment holistic, looking at many areas of the M&I curriculum?
- What methods are used to assess the child?
- Where are assessments carried out – could different locations be used?
- In relation to assessments of the environment:
When are environmental assessments carried out? Is it on request (by schools, parents or others) or automatically at key points in a child’s childhood, e.g. at points of transition to a new school, or a mixture of both?
- Who has responsibility for carrying out environmental assessments?
Useful Links / resources
Mobility and independence educators who were interviewed identified the following resources as being very helpful in informing their practice, particularly for carrying out assessments:
Brown D, Simmons V, Methvin J, Anderson S, Boigon S and Davis K (1991) The Oregon Project for Visually Impaired and Blind Preschool Children. 5th Edition. Medford, Oregon: Jackson County Education Service District.
Cork F, Foulstone M, Jackson V, Morgan J, Perry B, Simpson L , York D (1999) VIEW-FHE Assessment Pack: Assessing students who are blind or partially sighted in Further and Higher Education. Stafford: Flash Ley Resource Centre.
Cratty B J, Sams, T A (1968) The body image of blind children. New York: American Foundation for the Blind.
Pogrund R, Healy G, Jones K, Levack N, Martin-Curry S, Martinez C, Marz, J, Roberson-Smith B, Vrba A (1995) TAPS: Teaching Age-Appropriate Purposeful Skills. 2nd edition. Austin, Texas: Texas School for the Blind and Visually Impaired.
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