A study of personnel preparation of teachers of learners with vision impairment and O&M services

TVIs in the US have been called upon to provide instruction in some aspects of O&M since the 1960s. At that time, there were very few university prepared O&M specialists (Weiner, 1980; Weiner & Sifferman, 2010). At the same time, there was also a belief that young learners benefited from learning to negotiate their environment without a mobility tool, and consequently an O&M specialist was not seen as necessary until junior high or high school (Costello & Gockman, 1966; Lord & Blaha, 1968; Mecklenburg Association for the Blind, 1965; Metropolitan Society for the Blind, 1963).

Lord and Blaha (1968), in the only research study found on this topic, identified an instructional model for preparing TVIs where, after receiving one course/workshop in O&M, TVIs were asked to teach pre-cane skills to their students to ready them for O&M instruction by an O&M specialist. Lord and Blaha (1968) also reported that they found TVIs lacked “time for systematic instruction, as responsibilities in the resource room prevented them from an adequate opportunity to follow up on the campus” (p. iv).

In the 1960s, US university TVI programs began including a course in O&M. The number of university TVI programs offering the course O&M for TVIs grew from one, in 1962, to 10 in 1969 (AAIB, 1962, 1968; Hill, et al., 1984; Weiner, 1980). The description of the role of TVIs in provision of O&M services was also found in the Council for Exceptional Children Standards (CEC). CEC standard VI4K11: “Strategies to prepare individuals for structured pre-cane orientation and mobility assessment and instruction” (2003, p. 109).

A review of state education websites indicated that 26 states required TVIs to provide some O&M instruction, whereas 11 states only expected that TVIs have knowledge of O&M services, and the remaining states published no expectation of TVIs with respect to provision of O&M services. Table 2 lists the states grouped by the amount of O&M services included in their TVI regulations.

The TVI role in providing O&M services is defined in past and current textbooks for TVIs (Dote-Kwan, 2014; Fazzi, 2014; Griffin-Shirley, Trusty, & Rickard, 2000). Although Griffin-Shirley et al. (2000) clearly stated that “O&M is a unique area of the Expanded Core Curriculum (ECC) for which a professional, other than the TVI, is largely responsible for instruction” (p. 531) the authors at that time maintained that “to enable a child who is visually impaired to move safety (sic) through the environment, the teacher of students with visual impairments should teach the sighted guide, trailing, and protective arm techniques …” (p. 541).

More recent texts on O&M services in EI settings named both the TVI and O&M specialist as O&M service providers. Dote-Kwan (2014) stated that the classroom teacher could consult with the TVI or the O&M specialist “regarding specific O&M techniques that the child needs to be encouraged to use inside and outside of the classroom …” and either the O&M specialist or TVI “can also provide assistance in analysing the school campus for realistic travel routes” (p. 547).

Fazzi (2014) defined the TVI’s role more narrowly stating that the O&M specialist was an essential instructor of O&M techniques and the TVI role was “to become familiar with the concepts and skills of O&M in order to effectively support O&M specialists in their efforts to teach students to travel as independently as possible … such as expecting the student to use the long cane during travel on specified routes” (pp. 248-250).

Interactive play and ambulatory exploration of the environment are important developmental activities for young children. However, recent studies have documented that preschoolers with vision impairment remain stationary and engage in solitary play in preschool settings (Celeste & Grum, 2010). These results point to a concern about access to high quality O&M instruction in the early years of learners with congenital vision impairment.

Learners with vision impairment are at risk of developing global developmental delays even with current early intervention methods (Celeste, 2005, 2007; Hatton, Ivy, & Boyer, 2013). Celeste (2005) stated that “children who are visually impaired are at a particular risk for delays in the motor, social, and self-help domains of development” (p. 44).

In 2013, Hatton, Ivy, and Boyer analysed the data on young children who were referred to specialised agencies providing services to learners with vision impairment between 2005 and 2011 (n=5,931). Of those, 28.3% were identified as having developmental delays, despite the fact that they were born with no identified additional disabilities. These developmental delays were related to limited sensory-motor opportunities that resulted from vision impairment.

Although federal law has identified the O&M specialist as qualified personnel, there are many states where regulations have tasked TVIs with the evaluation, provision, and oversight of O&M services. This situation suggests that for decades TVIs have at a minimum been in the role of providing support for O&M services, and at a maximum evaluating, teaching and/or overseeing their students’ O&M needs for basic skill, or pre-cane skill acquisition, especially for younger learners in EI and preschool settings.

Now that federal law designates the O&M specialist as the qualified personnel for providing O&M services, an important question arises: what is taught in the TVI personnel preparation courses in O&M? The purpose of this study was to survey instructors who taught the O&M course for TVIs in the United States to learn what aspects of the O&M curriculum the course covered and for what purposes. The study was approved by The Hunter College Human Research Protection Program (HRPP) Office.

A list of TVI personnel preparation programs in the United States was generated through online websites that listed TVI programs. Forty programs were identified although only 35 programs were currently being offered. An email that included a brief description of the study together with informed consent was sent to program coordinators. The coordinators were asked to forward the link to the survey to any faculty or staff (i.e., instructors) who taught the O&M for TVIs course.

Five of the 40 programs contacted were no longer offered (Table 3). Of the remaining 35 programs, 30 surveys (i.e., 30 respondents) from 29 programs were received providing a response rate of 82.8%. Two respondents did not complete the survey in full and two surveys were submitted by faculty of the same university. As this was a survey of the course ‘O&M for TVIs’, all responses were included in order to best reflect how the particular course was characterised by those who taught it.

Table 3.

Of the 28 TVI program instructors completing the survey in full, 24 indicated that they offered one course in O&M as part of the TVI curriculum. Three programs covered the material in multiple courses that also included instruction in daily living skills.

Specific areas of O&M instruction covered

Respondents were asked to indicate whether they covered any of the 10 general areas of O&M instruction (Figure 1). One respondent indicated the course taught none of the 10 O&M areas listed, and wrote, “I am unsure of what we are talking about here … we explain devices but we do not teach these beginning students how to use them.” Graph 1 shows which areas of O&M content were covered (yes) or not covered (no) in the course.

Figure 1.

One respondent who indicated that specific skills in all 10 O&M general areas were covered by the course wrote, “… this is not a course that is designed to have TVIs teach O&M, but to be familiar with O&M so that TVIs can support the OMS with follow-up and make referrals to O&M …”

Twenty-eight respondents completed this section of the survey. When a general area was selected ‘yes’, respondents were asked to select from specific skills taught within the area. For each specific skill selected, respondents were asked to indicate the reason (Skills Practice, Teach, Referral, and Evaluation) for teaching that skill. A ‘reason percentage’ was calculated by dividing the number of times a reason was selected by the number of times that skill was selected.

Twenty-seven of 28 respondents (96.4%) taught guide techniques. All 27 selected basic guide, narrow passageway, and reversing directions. Twenty-six respondents selected transferring sides and doors and 25 respondents selected accepting/refusing aid, stairs, and seating. The reason percentage of guide techniques was: Skills Practice (89.4%), Teach (39.8%), Referral (25%), and Evaluation (16.2%).

Twenty-seven respondents (96.4%) selected orientation strategies. All selected landmarks, cues, and clues. Fewer selected non-visual (n=24) and low vision (n=23) orientation strategies, soliciting aid (n=21), the cognitive process (n=21), map skills (n=19), compass (n=18), numbering strategies (n=9), and smartphone apps (n=16). The reason percentage of orientation strategies were Skills Practice (96.8%), Referral (40.3%), Teach (25.5%), and Evaluation (7.8%).

Twenty-six respondents (92.9%) selected non-cane techniques. All selected trailing and traversing open doorways. Twenty-four selected direction taking, search patterns, and dropped objects. The reason percentage of non-cane techniques was Skills Practice (83%), Teach (42.1%), Referral (25.8%), and Evaluation (12.1%).

Twenty-six respondents (92.9%) selected both upper and lower hand forearm techniques. The reason percentage of protective techniques was Skills Practice (88.5%), Teach (38.5%), Referral (30.8%), and Evaluation (11.5%).

Twenty-four (85.7%) respondents selected O&M knowledge and skills. All selected teaching concepts (e.g., spatial, positional, environmental, and time), orientation concepts and O&M terminology. Fewer selected using sensory information (n=23), O&M screening (n=22), teaching learners with multiple impairments (n=21), travel practice at school (n=15), travel practice in the community (n=10), travel practice at home (n=9) and travel in adverse weather (n=5). The reason percentage of O&M knowledge and skills was Skills Practice (80.8%), Teach (26.2%), Referral (42.6%), and Evaluation (9.3%).

Twenty-two (78.6%) respondents selected mobility tools; all of those respondents selected Adaptive Mobility Devices (AMDs). Fewer selected teaching parts of long cane (n=21), vision as a mobility tool (n=20), dog guides (n=18) and electronic travel aids (n=16). The reason percentage of mobility tools was Skills Practice (62.0%), Referral (49.7%) Teach (3.9%), and Evaluation (2.9%).

Nineteen (67.8%) respondents selected cane skills with a guide. Of those, 17 respondents selected cane placement and walking with a guide. Fewer selected accepting/refusing aid (n=16), doorways and transfer sides (n=15). The reason percentage of cane skills with a guide was: Skills Practice (92.4%), Referral (27.5%), Evaluation (15.0%), and Teach (17.3%).

Thirteen (46.4%) respondents selected cane skills. All of those respondents selected touch technique and constant contact touch. Twelve selected diagonal, diagonal trailing, contacting objects, and ascending/descending stairs. Fewer selected doorways (n=11) and changing hands (n=10). The reason percentage of cane techniques was Skills Practice (89.2%), Referral (30.1%), and Evaluation (2.7%) purposes. No respondents indicated TVI students were to teach cane techniques.

Six (21.4%) respondents selected outdoor/residential. All selected the specific skill “introduction to outdoor travel”. Of those, five selected shorelining. Fewer selected touch and drag (n=4), residential street crossings (n=3), sidewalk recovery (n=3), street crossing recovery (n=3), touch and slide (n=3), 3-point touch (n=1), and car familiarisation (n=1). The reason percentage of outdoor residential skills was: Skills Practice (90.7%), and Referral (54.4%). No respondents indicated the reason was to Teach or Evaluate these skills.

Six (21.4%) respondents selected outdoor/commercial skills. Of those, five selected elevators. Fewer selected escalators (n=3), pedestrian traffic controls (n=2), revolving doors (n=1), sequencing for lessons on street crossing (n=1), and subways/EL trains (n=1). The reason percentage of outdoor/commercial skills was Skills Practice (18.5%), Referral (5.6%), and Evaluation (3.7%), with no respondents indicating the reason was to Teach these skills. Buses, Airport Terminals, and Primary Commercial Facilities were the only O&M techniques not selected by any respondent.

Respondents were asked the number of hours TVI students spent learning skills wearing blindfolds and low vision simulators. The highest number of hours with blindfolds was 40 and the lowest was two hours with an average of 12.3 hours across the 28 respondents. The highest number of hours spent using low vision simulators was 10 and the lowest was zero with an average of 2.8 hours.

Thirty respondents completed all or part of the survey. Human guide techniques, orientation strategies, protective techniques, and other non-cane skills were the most commonly covered O&M techniques and strategies in the O&M for TVIs course.

Skills practice was the most common reason selected for teaching any of the O&M skills. The second most commonly selected reason depended on which skill was being discussed. Teach was the second most common reason selected for teaching guide techniques, non-cane techniques, and protective techniques.

Referral was the second most common reason for covering the remaining skills. Evaluation was the least often chosen reason for teaching any of the O&M skills. This suggests that personnel preparation programs continue to define the role of TVIs with respect to O&M services as responsible for teaching non-cane skills. The TVIs are being taught to refer for O&M services for more complex travel.

In spite of the advances in O&M services, instructor preparation, and federal law, it would appear that the course O&M for TVIs continues to teach an instructional model created in the 1960s. The most frequently required textbook was TAPS, which was written 20 years ago, whose content was unchanged in the 2006 reissue, and was “designed to be used by O&M practitioners who work with children 3-21” (Hill, 2006, p. vii). Most of the texts used in these courses were O&M textbooks.

CEC has never created O&M standards for O&M services. However, about half of the O&M for TVIs course objectives were reported to be aligned with CEC TVI standards, standards intended for the TVI, but not specifically written to address the O&M needs of children. About half of the O&M for TVIs course objectives were directed at O&M assessment, evaluation, creation of Individualized Education Program (IEP) objectives, and teaching O&M by TVIs. The O&M standards used to support these course learning objectives were taken from the ACVREP O&M certification handbook, which was developed specifically for O&M specialists, not for TVIs.

While there has been a paradigm shift in federal law with respect to the education of learners with vision impairment receiving O&M services from O&M specialists, there appears to be status quo with respect to the instruction and expectations of TVIs in provision of O&M services. One contributing factor might be that most states provided no standards for the O&M specialists on the state education websites. In addition, some states that identified the O&M specialist qualification used out-of-date certifications such as AAWB and AER, or included qualifications such as certified teacher, RT, OT, and PT.

Some states charged TVIs with the provision of O&M services and some university personnel preparation programs of TVIs covered O&M instructional strategies. However, none of these single courses could be considered sufficient to enable TVIs to adequately teach O&M skills and techniques as reflected in ACVREP O&M certification requirements. Despite the professional literature that indicated the TVI was equally prepared to address EI O&M services, this survey suggested that TVI pre-service preparation in O&M makes this unlikely.

Given the findings of this study, the bigger question needing to be studied returns to the original premise of the O&M for TVIs course, which is: “Do learners with vision impairment need to attain prerequisite skills and pre-cane or basic skills prior to beginning ‘formal’ O&M instruction taught by an O&M specialist?” However, the fact that in Federal Statute, IDEA Part C (2004) O&M begins in early intervention and names the O&M specialist suggests that there are no prerequisite skills needed prior to the start of O&M instruction, and the O&M specialist is best equipped to provide O&M services.

The study findings and the current patchwork of O&M service delivery to learners with vision impairment demands an examination of options at the state level and in personnel preparation programs. One option might be to find a way to make it easier for states to hire O&M specialists. For example, create a new pedagogical designation to stand beside the TVI, i.e., a teacher of O&M. This could be assisted by CEC creating O&M standards and the O&M personnel preparation programs requiring their students to complete general or special education certification programs in addition to the O&M coursework. This might then enable states to include O&M teacher, separate and apart from the TVI teacher, as part of their state education regulations.

Another option might be for states to adopt O&M licensure. O&M licensure would place O&M specialists on par with other allied health professionals like PTs and OTs. While a third option might be for states to agree upon a mutually acceptable national certification process, the educational requirements for either of the two current O&M national certifications are not equivalent to teacher education standards required by most LEAs.

Without a universally recognised credential in O&M, the most important question is whether or not students with vision impairment are receiving vital services when they need them from adequately prepared personnel. Based on the data from this survey, there is little evidence that TVIs are equipped to provide the O&M services they have been, or may be asked to provide by state education departments.

Without a new approach to address the serious concern of identifying the credential of the O&M service provider, and appropriately defining the roles and responsibilities of the TVI and the O&M specialist in O&M instruction, learners with vision impairment will continue to be at risk of not obtaining O&M services from qualified O&M professionals.

This study is limited as not all of the university programs participated and it has not been replicated. Content validity was established with a small number of university instructors and no measure of reliability was obtained.