Steps to Indendence

Room 3 - Delivery Room (Section 5 of 12) 

Section 5 - Intervention

Description of the intervention stage

The intervention stage involves the teaching of a mobility and independence programme to the child and may involve input from several people and agencies. Intervention is very complex since there are many different factors to consider. The research suggests that different people (e.g. Teaching Assistant, Class Teacher, Mobility Officer, QTVI, parent) often take on different roles (such as ‘tutor-role’, a ‘reinforcer-role’ and an ‘advisor-role’), depending upon which aspect of the mobility and independence curriculum is being covered (e.g. travel skills, independent living skills). There are also many challenges to be overcome, particularly in negotiating and securing time for mobility and independence lessons, particularly within school hours.

The first part of this section covers responsibility for mobility and independence, including consideration of the area of the mobility and independence curriculum being covered, the different roles of key people, including the Mobility and Independence Educator, QTVI, Class Teacher, Teaching Assistant, and parents / family, and implications for safety and insurance.

The second part covers time for mobility and independence lessons, including consideration of the implications of mobility and independence lessons both in school time and out of school time, including school holiday provision.

Responsibility for M&I education

Few Mobility and Independence Educators provide mobility and independence education totally unaided or alone. Mobility and independence education should be a shared responsibility between people involved with the child, including QTVIs, school staff, families, and other agencies such as social services. The Mobility and Independence Educator is often the key professional who co-ordinates the delivery of mobility and independence support, ensuring that different people know how and when to play their part.

Activity 14

You will probably be aware from your experiences to date that the M&I educator’s role is a broad and varied one. Before reading on consider at least two roles that an M&I educator might adopt in providing input to children with visual impairments.

 

We found it useful to conceptualise three different but overlapping roles adopted by the Mobility and Independence Educator. Mobility and Independence Educators will usually adopt all of these roles at some point, depending upon different parts of their job.

The first is where the Mobility and Independence Educator takes on the role of personal tutor, involving one-to-one teaching with the child, without the intervention of other professionals or people. The mobility and independence educator will often focus upon technical aspects of mobility and independence such as mobility techniques, cane techniques, the use of tactile maps, or introducing a new route, for example, teaching a child a route to the local shops in their home area, or a new route around their school. Such sessions from specialist staff are crucial in teaching children fundamental techniques, which can then be practised and perfected. It may also be that the mobility and independence educator is trying to work out appropriate ways of teaching a particular skill, and having a third person present might be an unnecessary hindrance.

The second role is where the MIE acts as an ‘advisory-tutor’. This role complements the first, in that the MIE still makes any decisions regarding progress through the programme and still carries out ‘hands-on’ teaching with the child, but gets others to reinforce what they teach. This appears to be a common practice. Reinforcement of mobility and independence skills is important as children need to practise them, and school staff and parents who spend more time with the child need to take on the responsibility of reinforcing skills the child has been taught by the mobility and independence educator. The following are examples identified from our research where others reinforce mobility:

The MO gets the teaching assistant to reinforce new routes within the school that she has initially taught. This ensures consistency, but the MO does not expect mobility outside of school to be reinforced as the risk is greater and the teaching assistant is not insured off the school premises. BIRMINGHAM

The MO gets the teaching assistant to reinforce cane skills with the child, but only if the child is at a certain level of competence – the teaching assistant accompanies the MO on lessons so they know what mistakes/incorrect use of cane to look for. DERBY CITY

The MO gets parents to reinforce safety skills (e.g. what to do if the child gets lost, how to use pedestrian crossings, etc) to ensure consistency in approach. BIRMINGHAM

An awareness and understanding of the importance of mobility and independence education (amongst teaching staff in particular) seems to equate with a willingness to take on the responsibility of reinforcing mobility education. QTVIs who may have regular contact with school staff and MIEs have an important role to play in raising awareness of the importance of mobility and independence.

It may also be useful to make reinforcement an expectation for some job roles, e.g. teaching assistants, possibly through inclusion of such a requirement in their job descriptions. In authorities where teaching assistants are employed by the sensory or visual impairment service, it is easier to get them on board than teaching assistants who are employed and managed by the schools.

To effectively reinforce skills, school staff and parents need support and training. Informal training can be carried out by the mobility and independence educator, on-the-job during mobility and independence sessions with staff or a parent watching, or in INSET sessions.

In order to maximise the number of children that can be supported, the MIE could work in an even more advisory role, making all decisions (carrying out assessments, designing programmes, and deciding when the child should move on to the next stage), and overseeing others to actually deliver the programme. This notion of having a mobility and independence assistant does not appear to be a common practice, though some Mobility and Independence Educators expressed a desire for having such an assistant to support them so that they could reach more children and/or address a wider range of skills.

An example from the research where this happens is the following:

The education service employs a Mobility Officer who has four ‘mobility assistants’ that deliver programmes designed by the MO to partially sighted children, under his guidance. Each mobility assistant has been trained by the MO to enable them to teach a child up to the first module of care training. The assistants are insured to work ‘off-site’ as well as on school premises, and are always accompanied by a third person. Children who are blind are still taught one-to-one by the MO.

To enable this to work effectively in practice, there needs to be appropriate support from management, in the allocation of time and resources which would enable the mobility and independence educator to train and support the assistants to a suitable level of competence in teaching. This might include the mobility and independence educator modelling good practice for the teaching assistant (or others) to copy. Since training is very time consuming, there may also be a case for sending assistants on accredited courses in mobility and independence to acquire certification (M&I Policy & Service Room).

A third role is that of ‘advisor’ where the Mobility and Independence Educator works in an advisory role. This could include:

  • Advising parents on pre-school mobility and independence issues and independent living skills.
  • Advising staff in special schools on mobility and independence skills for children with MDVI.
  • Raising awareness about mobility issues with a child’s peer group.
  • Giving health and safety advice to staff on PE lessons or about school trips, and
  • Carrying out environmental assessments (see section on Assessment).

In effect, the Mobility and Independence Educator is akin to a consultant, a specialist in mobility and independence offering expert advice. The following are two examples identified from the research study:

The MO advises staff in some special schools on how to do mobility and independence work with children with MDVI since the children may respond better to school staff that they know. DUDLEY

A QTVI who has responsibility for the pre-school caseload in the authority advises parents on how to support and encourage their child’s development in mobility and independence. This ensures prerequisite skills are in place for when the child is of school age when the education MO takes over. HULL

Safety and insurance implications also need to be considered since mobility and independence work is inherently risky. Although one of the primary aims of mobility and independence education is to equip children with skills that enable them to move about safely, it is impossible to eliminate all potential risk without denying children experiences they need to have. Mobility and independence education, particularly activities conducted off school premises, must have insurance cover. Mobility and independence educators should be covered for activities carried out both on and off school premises, including any activities outlined in their job descriptions. This should be the responsibility of their employer.

Other key people should be insured for carrying out responsibilities delegated to them, such as reinforcing mobility and independence skills with children. In practice it seems to vary as to what teaching assistants are covered for; if employed by the education visual impairment service, they are sometimes insured to carry out work off school premises with the child, but if employed by the school, they are rarely covered for off site work. Most are unclear about the extent and nature of any insurance cover. It appears that few QTVIs are covered for out of school activities.

Time for M&I education

As mobility and independence spans across and reaches beyond the boundaries of school education, mobility and independence education can take place both in and out of school hours. In practice, most mobility and independence education is carried out within school time since this is when most mobility and independence educators are contracted to work. However, we also identified examples of mobility and independence being taught out of school hours, and during school holidays. For example, mobility and independence educators employed by education seem to work predominantly within school time, whilst social services mobility and independence educators often work outside school hours, with an emphasis on home area work. Generally though, most mobility and independence educators seem to work both in and out of school hours, the emphasis depending on individual circumstances.

Mobility and independence education can be very time consuming, and it is often difficult to gauge how much input a child will need. Mobility and independence educators have to work at the pace of the child, which can be affected by the child’s age, natural ability, self-confidence, and other disabilities they may have. It can also take time to get to know the child, which is essential in order for them to trust the mobility and independence educator, since mobility and independence can sometimes seem formidable to a child. This presents a challenge when trying to timetable assessments and mobility and independence lessons, whether in or out of school time.

Activity 15

Given the possible tensions identified above regarding time considerations, try to note down at least three strategies that you have used, or potentially could draw upon when negotiating time to implement an M&I programme. You can then compare your list with the strategies we identified in the M&I research project.

 

In school time

The mobility and independence curriculum competes with the National Curriculum for space in crowded timetables. For some aspects of mobility and independence, children are taken out from lessons, or miss their break times. This requires negotiation, choices regarding lessons to miss, and solutions to overcome these tensions.

In terms of negotiation, the mobility and independence educator may do this or a QTVI on their behalf (this may be particularly important when the mobility and independence educator is from an agency outside education). Negotiation is necessary with a variety of people depending upon the school and age of the child, including parents and the child (regarding preferences for missed lessons), class teachers (particularly in primary school), Heads of schools, Heads of year groups, and SENCOs. Negotiation is generally easier when mobility and independence is included on a child’s statement, and when there is a good level of awareness of the importance of mobility and independence amongst school staff.

Common subjects and times when mobility and independence lessons take place are reportedly:

  • Lessons which are not perceived as ‘academic’, or those the child may not be taking for a GCSE – generally PE, Music, Art, Woodwork, and some aspects of Technology.
  • Personal social and health education.
  • Tutorials.
  • ‘Free’ periods in secondary school.
  • Lunch breaks.

Activity

Before you read on, try to note down one disadvantage of removing a child from each of the times and subjects listed above, for M&I education. You can then compare your answers to those identified in the research project, and described below.

 

However, many of these times are important for children with visual impairment to be experience. For example, break times are important opportunities for children to socialise and interact with peers, and food technology may give opportunities to cover some aspects of independent living skills. Therefore, many education services try to cover independent living skills within the school day without having to remove the child from any classes. This is often achieved by the QTVI teaching the child skills at appropriate times, such as dressing before PE lessons, eating skills at lunch breaks, and food preparation skills within food technology classes.

Several strategies that may be adopted regarding the negotiation of time were identified:

  • The mobility and independence educator should be prepared to be flexible.
  • It may be easier to negotiate access for shorter programmes than ongoing programmes.
  • Different lesson times are negotiated to ensure the same lesson is not missed consistently.
  • Incorporating aspects of independent living skills into National Curriculum subjects, e.g. PE, food technology.
  • Seeing the child out of school time (considered in later sections, ‘mobility and independence lessons out of school time’ and ‘mobility and independence provision in school holidays’).
  • Each case is unique – the benefits and disadvantages of missing different subjects have to be considered for each individual child.
  • The child and their family may have to choose between mainstream subjects and the mobility and independence curriculum.

Examples identified in the research include:

There is a need to be flexible in mainstream schools – the MO tries to go in to mainstream schools on alternate days so the same lessons are not missed consistently. BIRMINGHAM

A benefit of a QTVI providing mobility and independence education is that they can be very flexible as to when they see the child for mobility and independence support. They can timetable alongside their ‘QTVI-work’ with the child. STAFFORDSHIRE

Ultimately however, it is important to recognise that this tension between time for mainstream education and additional time required for the mobility and independence curriculum cannot always be easily overcome.

Out of school time

Mobility and independence lessons also take place before and after school, on occasions where the child’s school or their parents do not want the child to be extracted from lessons at all. Often these times are more appropriate for the type of mobility and independence skill being covered.

Examples identified from the research include:

When the child needs to learn the route from their home to their school then it is arranged at a relevant time. This is particularly important if public transport will be used because they need to know the correct bus timetable, and how busy the route will be with traffic and other pedestrians at that time of day. PLYMOUTH, LEICESTERSHIRE

If the child is affected by night blindness, they would need to have mobility and independence support after school in appropriate lighting. PLYMOUTH, N YORKSHIRE, DERBYSHIRE

Mobility and independence skills in the home area or away from school premises tend to take place after school time, as they require a lot of time to travel to the area (e.g. town centre) and to carry out the lesson. LEICESTERSHIRE

Activity 17

Before reading on, note down at least 3 advantages and disadvantages of providing M&I input to a child after school hours.

You may also wish to note down 3 advantages and disadvantages of offering M&I input during the school holidays.

You can then compare your notes with the findings from the M&I research project which are reported below.

 

An advantage of working before or after school hours is that many children are embarrassed to have mobility and independence lessons in front of their peers during school time. However, there are also disadvantages. The most obvious one is that at the end of the school day, children are tired, suffering from visual fatigue if they have some useful sight, and may not be able to concentrate as well as they need to. Mobility and independence work is very intensive and physical, therefore after school when children are tired is not the optimum time to learn new skills. This is particularly the case for young children.

A further problem is that most mobility and independence educators, whether employed by education, social services, or a voluntary organisation, are typically contracted to work set hours, typically from 9.00am to 5.00pm Monday to Friday. Clearly it is impossible to see all of the children on their caseload after school time, between 3pm to 5pm. This is where flexibility is very important; many mobility and independence educators tend either to work extra hours, or work to a more flexible schedule so they can see children at appropriate times. This appears to be successful where management gives time off in lieu of any extra hours worked, or does not stipulate that the mobility and independence educator should work to a rigid, set timetable. Examples identified in the research project of flexible working by the mobility and independence educator include the following:

An outside consultant employed to provide mobility and independence education, works predominantly after school and even on weekends to avoid the child missing lessons in school, reduce potential embarrassment for the child in front of peers, and teach out of school activities. COVENTRY

A SSD Rehabilitation Officer works with children after school hours despite being contracted to work 9-5pm. This is because the mobility and independence lessons can be long and he doesn’t want the child to miss too much of school. It also reduces embarrassment for the child because it is not in front of his/her peers. The RO is given time off in lieu. PLYMOUTH

The provision of mobility and independence support during school holidays seems to vary widely around the country. The decision as to whether individual children need continuing or one-off mobility and independence support in the holidays should be left to the informed, professional decision of the mobility and independence educator. For some children, reinforcement over the holidays is crucial so that their progress is not set back, or where there is concern over their ability to transfer mobility and independence skills taught in school to the home environment. It is also important for children who are transferring to new schools, since the summer holidays are a good time to do familiarisation work within the new school building/grounds when they are empty.

There are many other benefits of mobility and independence education during the holidays; in particular, it is a good time to work with and advise parents, and get them on board so that they can reinforce mobility and independence skills. The child may also be more relaxed at home than in school, and less embarrassed when not having to do mobility and independence lessons in school in front of their peers. It allows longer sessions to be carried out, to learn skills further afield from school or in the child’s home or home area. It is also a good opportunity to cover independent living skills, often neglected in school time, within the home setting by encouraging and supporting parents to take on the responsibility for independent living skills. It is also an opportunity to encourage children to access leisure activities.

The mobility and independence educator may plan to work with different people according to the time of year, for example with school staff during term time and with families during the holidays.

Some examples of why mobility and independence education is beneficial during the holidays include the following:

One RO believes it is important to carry out mobility and independence education during the holidays in order to reduce the disruption to the child’s National Curriculum timetable in term time. LONDON BOROUGH OF RICHMOND

The Co-ordinator for Mobility and Rehabilitation Services does long route training and general awareness training in the holidays – this includes everyday activities that many children with visual impairment miss out on, such as going shopping, eating in a café, bus and train travel. These are too time-consuming to do in term time. NEWHAM

Although it may not be essential for all children, a child should always have access to holiday provision since mobility and independence is a year-round life skill. In areas where mobility and independence education is provided by social services or a voluntary organisation, access to holiday provision is normally provided since these providers work year-round unlike many mobility and independence educators employed by education who are contracted to work term time only. In authorities where the mobility and independence educator is not contracted to work in school holidays, children can be referred to another agency for mobility and independence input, for example social services or a voluntary organisation. Where this occurs it is important that the different agencies share information about the child and their progress. Examples where school holiday provision is successfully taken on by other agencies include the following:

The education service sends copies of their monitoring sheets for each child to SSD, and SSD reciprocates by sending them reports of what they did with the child in the holidays. Often the SSD MIE would accompany the education MIE on lessons, and hold joint meetings two or three times per year to discuss children’s progress. NORTH YORKSHIRE

The education Mobility Nursery Nurse keeps SSD informed of all the mobility and independence education children receive so that when they work with the children during school holidays they are aware of the child’s progress. ROTHERHAM

Issues concerning multi-agency involvement are discussed in more detail in Section 3 of the M&I Policy & Service Room

Recommendations based upon good practice

Responsibility for mobility and independence education

Many people have responsibilities in the delivery of mobility and independence education. The key dimensions in deciding who is responsible, and when, are:

  • The roles being adopted (i.e. tutor, advisory tutor, advisor),
  • The part of the mobility and independence curriculum being covered, and,
  • The aspect of the delivery being considered (i.e. referral through to completion).

Potential options for allocating professionals/people to different responsibilities is covered in another room (M&I Policy & Service room). However, key recommendations can be summarised as follows:

  • The education service for visual impairment should be responsible for clearly defining roles and responsibilities for delivering the mobility and independence curriculum (even if some of it is provided by other agencies).
  • Many aspects of mobility and independence education require intensive one-to-one tutoring requiring specialist professionals (i.e. QTVI, Mobility Officer, Rehabilitation Officer).
  • Reinforcement of mobility and independence skills that the Mobility and Independence Educator introduces is important; key people to reinforce aspects of mobility and independence under the instruction of the Mobility and Independence Educator are Teaching Assistants in the school environment, and parents in the home environment.
    The important role of mobility and independence awareness raising and ‘recruitment’ of those working most closely with the child should be recognised when managing provision.
  • Some aspects of mobility and independence intervention, particularly reinforcement, may be suitable for Teaching Assistants with appropriate specialist training – the notion of a ‘Mobility and Independence Assistant’.
  • Provision of all aspects of the mobility and independence curriculum (including independent living skills, and early and foundation mobility and independence for pre-school children) should be recognised and should involve close liaison with professionals and parents.
  • Health and safety aspects of mobility and independence curriculum delivery must be considered, and the necessary insurance cover taken out by the employer of the staff involved.

Time for mobility and independence education

  • One person should be responsible for negotiating time for mobility and independence sessions, with the key contact in a given school. The mobility and independence policy should clearly identify these people by job title (and name if possible).
  • Time allocated for mobility and independence should be considered on each case’s individual circumstances. Factors include age, the type of mobility and independence need they have been referred for, the appropriate time of day for learning the skill, the impact of missing certain lessons if it has to be in school time.
  • If children have to be taken from lessons, different times should be negotiated to ensure the same lesson is not consistently missed.
  • Children should have access to mobility and independence support in the school holidays if required.
  • Continuity of provision between school and home (and school holidays) should be demonstrated.
  • It must be recognised by all involved that mobility and independence education takes time. It may be appropriate to offer some children with visual impairment (and their families) time-tabling options so that they can make appropriate choices, e.g. reducing non-core foundation subjects to allow for more mobility and independence time, or vice-versa.
  • Time should also be available for the mobility and independence educator to advise others working with the child.

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