Paths to Literacy

for students who are blind or visually impaired

What to Include in an IEP for a Student Who Has CVI

Collage of IEP for students who have CVIWith the help of TVI Matt Tietjen*, we have compiled a list of considerations when writing an Individualized Education Program (IEP) for a student who has cortical visual impairment (CVI). IEPs look different from state to state, but contain the same information. If you are a parent or a provider who works with a child with CVI, no matter where you live, here are some ideas to think about. It should be noted that our source for all discussion of CVI, the phases, the ten characteristics, accommodations and modifications is Cortical Visual Impairment: An Approach to Assessment and Intervention (2007, AFB Press) by Christine Roman-Lantzy.
 

Training on Cortical Visual Impairment

Due to the lack of awareness and knowledge of CVI among providers, let’s start with ongoing training on cortical visual impairment. The place to do that is in the IEP under Support for School Personnel. When you specify CVI training for the educational team, it is exactly that – it is for the entire team and cannot target individual team members, such as vision teachers or new team members. When adding this, you should also note the frequency of CVI training (monthly, quarterly, annually, etc.).
 
Speaking of CVI training, we all know that every student with CVI should have an IEP team member who is CVI Endorsed. You can make this request to the student’s IEP team.
 

About Accommodations and Modifications

Many accommodations and modifications are directly related to the CVI ten characteristics (Roman-Lantzy). These would go under the Program Accommodations/Modifications section in the IEP. A good standard is one objective (or goal) for each unresolved CVI characteristic (we do not include the reflex characteristic).
 
Remember that “accommodation” is not a synonym for “goal.” Accommodations are different than IEP goals and objectives. Accommodations are meant to ensure that work is designed to meet a student’s current level of ability in these areas. Goals and Objectives are to help him move beyond his current ability in these areas.
 
For example, consider a child with CVI who can recognize realistic color photographs of objects, but is unable to recognize images that are more abstract. This would fall under the CVI characteristic “difficulty with complexity of objects,” which includes many types of visual identification tasks. Since the bulk of educational materials (think worksheets, children’s books, etc.) feature cartoonish illustrations, clip art, black and white line drawings and other types of abstract imagery, this child would clearly need an accommodation so that materials are accessible. The accommodation might read: “substitute real, color photographs for illustrations in books and clip art on worksheets.” This accommodation recognizes the child’s “difficulty with complexity of objects” characteristic and ensures that the child will be able to interpret the books and worksheets he is given in class.
 
At the same time that we recognize the child’s difficulty in this area (accommodation), we also need to recognize his potential for growth in this area (goal). We could set a goal that, “child will improve his ability to interpret 2D images.” An example of an objective under this goal might be, “Given a realistic color photograph of an object and a black and white line drawing of the same object with salient features (Roman-Lantzy) highlighted in child’s preferred color, child will point to the salient features on the color photograph and then point to the corresponding salient features on the black and white line drawing.” So, we would be using an accommodation and a goal to address the same characteristic – the goal to encourage the child’s growth in this characteristic, and an accommodation to ensure that class materials given to the student are accessible and reflect his current difficulty with this characteristic. In other words, we write the accommodation with our eye on the child’s present and the goal with our eye on the child’s future.
 
Original black and white math worksheet  Worksheet with color highlighting
 

Ideas for Accommodations and Modifications

We can use information from the child’s CVI Range Assessment to generate accommodations and modifications for the IEP. Specifically, we can use the information from Rating II (which indicates how the child is presenting in each of the characteristics) to write accommodations for nine of the ten characteristics (we do not include blink reflexes) (Roman-Lantzy). Below are some examples of specific accommodations with the relevant characteristic in parenthesis:
  • Bold color marker for writing (Color)
  • Highlighting school worksheets and materials in student’s preferred color (Color)
  • Use of iPad for backlighting of materials to increase visual attention and decrease visual fatigue (Light, Complexity)
  • Use of slantboard (Visual field)
  • Use of visual occluder (Complexity of array)
  • Extra time to look at materials (Latency)
  • Allow for close range examination of materials (Complexity of array)
  • Preferred seating. This will look different for each student and should include factors such as visual field, light (facing away from windows) and movement (busy school hallways), and the amount of visual complexity within the student’s visual field. Alternatively, you could say, Use black fabric to reduce visual complexity within the classroom (Visual field, Light, Movement, Complexity of array).
  • When looking at pictures of objects, highlight and talk about 2-3 salient features (Roman-Lantzy) (Color)
  • When looking at new objects or pictures, use Comparative Language to talk about how the item is similar or different to an object the student is familiar with (Roman-Lantzy)
  • When introducing new sight words, add a red bubble outline around the word and discuss salient features of the word (listen to Dr Roman on Phase III literacy here)

New words highlighted with yellow and outlined with red bubble

  • Orient work sheets and materials left to right, for purposes of preliteracy (Visual field)
  • Vision breaks are so important for students who have CVI. These should happen in an area with little visual or sensory input. For some kids, this can be as simple as the child closing his eyes and resting his head on the desk for a few minutes.
  • No laminating. Or opt for matte laminate, a non-glossy laminate that works better for some students. No glare. (Light, Movement)
  • Link the accommodation to the CVI Characteristic (color, complexity, light, novelty, etc.). An example is “Close examination of materials (Complexity).” Close examination is not about acuity – it allows the student to reduce complexity by blocking out background visual information that makes it harder for the student to look at the object.
  • Student orientation to new classroom and teacher prior to the first day of school (Complexity, Movement, Novelty, Sensory Complexity). Orienting to a new classroom and teacher should happen before the first day of school, in an environment with reduced sensory complexity. Focus on meeting the new teacher, learning the classroom layout, finding the student’s desk and cubby, and orienting to a new classroom location within the school building.
  • When writing IEP goals, build the accommodation into the goal, including non-vision goals (“Susie will cut a 1/4″ thick red line with scissors”)
  • Personal copies of materials for morning meeting (calendar, attendance, word of the day, weather, etc.). Even if a student is sitting close enough to see the materials from an acuity standpoint, the complexity from a distance of even a few feet is often too much to process even for some children in Phase III (distance, complexity of array).
  • Personal copies of all important wall materials (word walls, class rules, math facts, etc.). Student can have a photo album on his iPad titled “wall materials” with a photograph of each item. While the class is reviewing the word wall, for example, the child can refer to the photo of the word wall on his iPad (distance, complexity of array).

 

We draw from the 10 characteristics to generate accommodations and modifications, and we also base goals and objectives on these characteristics. A good standard is one objective (or goal) for each unresolved CVI characteristic (we do not include the reflex characteristic). A goal to address visual fields for a child with a right visual field preference might look something like this: “given a preferred, visually alerting item placed slightly left of midline on her tray, in a quiet, visually simple environment, student will search for and locate the item.” Sometimes, in lieu of a separate objective to address each characteristic, some goals or objectives may incorporate several characteristics. Let’s consider this example: “After pointing to the salient features on a familiar photograph of an item, student will point to the corresponding salient features of a novel photograph of a different exemplar of that item.” This characteristic addresses “complexity of object” and “visual novelty” simultaneously.
 

Expanded Core Curriculum (ECC)

The Expanded Core Curriculum (ECC) is another important source of goals and objectives for a child’s IEP. The ECC is essential for all children with visual impairments, including those with CVI. The ECC provides essential skills needed for independent living and working and includes the following areas: Compensatory or functional academic skills; Orientation and mobility; Social skills; Independent living skills; Recreation and leisure skills; Career education; Assistive technology; Sensory efficiency skills; Self-determination or self-advocacy. There is some overlap between these areas (i.e. some sensory efficiency skills are also compensatory skills; some technology skills are compensatory skills; etc.). Here are a few examples:
 

Compensatory Skills  – This may be the least self-explanatory area and can look so different for each child!

  • Using objects or images to represent items from a choice board, communication system, daily schedule, or story
  • Teaching a child listening comprehension, so that he can access the curriculum through auditory text either because she cannot read words yet or in order to have the option to continue reading while taking a visual break.
  • Teaching a child to color highlight passages of text and other materials to help reduce complexity of array and enable her to access those materials.

 

Sensory Efficiency Skills

  • Employ color coding to a child’s daily schedule system to teach her to read, and set up the schedule from left to right. For example, have a green dot at the beginning of the schedule and a red dot at the end of the schedule and teach child to organize schedule from green to red.
  • Teaching salient features (Roman-Lantzy) to help child build visual identification abilities.
  • Color coding of items on child’s lunch tray (i.e. spoon is yellow, bowl is blue, etc.) so that child can use vision to locate meal items more efficiently and with less visual fatigue during lunch time.

 

For Students on an Academic Track

Students with CVI who are on an academic track need to have an accessible version of all curriculum materials at the same time as their typically-sighted peers. Even for many children in Phase III, nearly all classwork must be adapted. Due to the high work volume and fast pace of the general education classroom, this is not something we should expect teachers or instructional assistants to do “on-the-fly.” Instead, it is often necessary to designate an instructional assistant (IA) or paraprofessional and give that person allotted time each day/week to modify or adapt student materials for the general education curriculum. For a student on an academic track, paraprofessionals should have at least 4-5 hours per week of material preparation time. The paraprofessional will also need to meet with TVI on a regular basis for training and collaboration on how to make modifications/accommodations. The general education teacher should get all work to the paraprofessional at least a week in advance for modifications.  Given the reality of stretched resources in many school systems, spelling out this arrangement in the IEP can help ensure that it is fully realized.
 

Present Levels of Performance

We can also use results of The CVI Range Assessment to write present levels of visual performance into the IEP (Roman-Lantzy). When we complete Rating 1 on The CVI Range, we indicate which visual skills the child is currently capable of. That information, statements marked with a (+) that currently describe the child’s vision, can be transferred onto the Present Levels of Performance page for vision.
 

Support with Goals and Objectives

In some instances it can be helpful to add a “CVI Characteristics/Objectives matrix” to the IEP. This is a table that lists each IEP objective with a visual component, the CVI considerations related to that objective, and appropriate visual supports and teaching strategies for that objective. The purpose is to leave the team with some detailed guidance around CVI teaching strategies when the TVI might not be available.
 
See the example below:
 
Objective CVI Considerations Suggested CVI Interventions and Teaching Strategies
2.1: student will identify items that belong to a given category (e.g. farm animals, things that fly, things that are cold, etc.)

Complexity of object:

Can student use the salient features of hte object or image to identify it? 

Can he recognize the salient feature that makes it the same or different from another group of objects?

  • Practice with categorizing objects and images (and using their salient features as clues) can be a great way for students with CVI to strengthen their object and image recognition abilities.

 

  • Consider using both 3D versions of the objects as well as realistic digital photographs of them. This is a great opportunity to focus on salient features with student. For example, say student is asked to sort "things that swim" from "things that walk." The activity could be done first with 3D versions of sea and land animals. Ask student, "fins or legs" and then have him touch a find or a leg on each animal to support his answer before sorting them into the correct area or bin. After he masters those objects, try the same activity with realistic, plain background 2D images of those same animals.
 
*Matt Tietjen is a teacher of the visually impaired (TVI) working in CT and author of What’s the Complexity, a framework for designing an accessible school day for students who have cortical visual impairment (CVI).
 
Collage for IEPs for children with CVI
 
 
 
 

Comments

Well done. School districts

Posted by Beth Ballinger

Well done. School districts are desperate for this information.

IEPs for CVI

Posted by brenda b.

Thank you, Beth. Parents too. We need a whole lot more of everything when it comes to serving students who have CVI.

Thank you for reading.

Honoring TVIs capacity

Posted by Nikki

This post offered insightful suggestions and recommendations to consider when developing and IEP for learners with CVI. Based on my experience, this information seems most helpful for caregivers, new TVIs, TVI with little experience with CVI, and non-vision trained professionals. I also was glad to see the delineation of informations into categories, especially the section regarding academic track. Too often, the information regarding CVI is stated in blanket terms as if all strategies are appropriate for any leaver with CVI. As we as special educators are building IEPs it is critical to keep the indivisible needs of learners (i.e., developmental/performance level, motoric abilities, and mobility access— to name a few) in mind when evaluating and determining the needs of each child.

In my work, I am an infant and todddler (ECEI) practitioner. I also use many of these suggestions within a functional context when creating IFSPs (indivisible family service plan). This resource also offers relevancy for the birth - four population as well. There are adaptations to consider as far as developmental and age-appropriateness of the outcome. These Include considering the natural environment and routines of the child/family.

I must also note that it is oncerning that the post appears to elude that a CVI endorsed TVI is mandatory to developing an appropriate IEP or meeting the needs of learners with this condition. Just like in any field in educational setting (i.e., communication, education, motor) there are practitioners who attain a specialized creditial. However, this does not negate the capacity or ability of a non-CVI endorsed TVI to be a skillful and extraordinary practitioner for the leaner with CVI but also just as competent in supporting the IEP (or IFSP) team (i.e., caregiver, teachers, related service providers).

re: Honoring TVIs capacity

Posted by Brenda from Sta...

Nikki, thank you for feedback. This post has been popular and my hope is that it is helpful. You could literally write a book on this topic. At some point, I would love to write a follow up post, and I'll definitely consider your feedback when that happens. Your comment about distinguishing modifications according to the CVI Phase is so important, and thank you for mentioning that.

This CVI/IEP blog post is also for parents - who are often the only ones advocating for their child with CVI amongst an IEP team that is hearing the words 'cortical visual impairment' for the first time. Many parents feel lost when it comes to advocating for the needs of a child with CVI, and especially when it comes to writing an Appropriate (as in FAPE) IEP for a child with CVI. The information here comes from my learning experience from raising a child with CVI, and from Matt Tietjen, who is a CVI Endorsed TVI and author of the What's the Complexity framework.

And yes - students with CVI do need somebody on the IEP who is CVI Endorsed (not necessarily the TVI). You are correct, there are providers who are proficient in CVI. But getting endorsed shows the parent that you are qualified to work with their child who has CVI. I remember my first conversation, six years ago, with Christine Roman and she made that important distinction - is the TVI qualified in CVI to work with my child? The answer has always been No. All too often - and I'm speaking from experience - the TVI claims to know CVI but has no idea how to work with my child, does not want to modify materials (Access), does not know how to write IEP goals etc. And they might even present a sort of "CVI resume,' Oh I attended a conference session on CVI three years ago, or read a paper on CVI, so I get CVI. That's not good enough. And parents are struggling - struggling - to find CVI competent providers. The only way to know is when the provider has that Endorsement. If you go to Perkins' CVI Endorsement webpage, it is explained similarly for parents. Parents need that assurance. The benefit to you, and others who attain an Endorsement, is that you can market your competency and experience in CVI. In the current environment, with such a lack of awareness of CVI, that CVI Endorsement speaks volumes. Every child with CVI deserves CVI competent providers. My hope is that some day, CVI Endorsement for students with CVI will makes its way into the IDEA. We have a long way to go.

Thanks again, Nikki.

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