(Characteristics-Hagood)

TSBVI TETN #30904 – Routines for Visually Impaired and Deafblind Students

TETN Broadcast #30904

Routines for Visually Impaired and Deafblind Students

September 24, 2008

1:30-3:30 PM

Presented by

Sara Kitchen, VI Consultant

sarakitchen@tsbvi.edu

And Chris Montgomery, DB Consultant

chrismontgomery@tsbvi.edu

TSBVI Outreach

What is a Routine?

Characteristics of a Routine (Linda Hagood)

· Beginning and end steps are clear

· Sequence is simple and predictable (can be expanded later)

· Student has multiple opportunities to respond

· Interactions are reciprocal with balanced adult/child turns

· Objects and actions are used to cue responses (rather than verbal or tactual prompts)

· Simple student responses are targeted

· Keep features consistent (people, actions, objects, locations, time)

Why Use Routines?

FOR THE TEACHER they provide:

· Stucture (organizes and event or activity and the instructional environment and materials, aids in daily and weekly scheduling of students and support staff, helps with lesson planning and documentation)

· Focus & Flexibility (helps in maintaining a focus on the student and student goals, also enhances opportunities for “teachable moments”)

· Positive Interactions (Decreases behavioral issues and increases bonding that are critical to student learning)

FOR THE STUDENT they provide:

· Predictability: "I know what is going to happen from start to finish."

· Consistency: "I know what I am supposed to do."

· Anticipation: "When you do that, I know to get ready for _______."

· Practice: "I remember what I did last time and I can try to do more this time."

· Stress Reduction: “Because I know what will happen, I am not afraid. When something unexpected or disliked occurs, I can take comfort in what is familiar and I know it won’t go on forever.”

· Concept Development: “I learn a word (symbol, signal, gesture, sign) has meaning in many different activities.”

· A Framework for New Experiences: “Because I understand what typically happens, new events or experiences are highlighted and have my full attention.”

Some Thoughts About Routines

· Routines begin as simple and highly structured events. They typically become more flexible as the student gains understanding and skills. This helps keep the routine interesting to both the student and the teacher.

· A routine provides a framework for the student to develop a sense of time as daily activities are broken into predictable “chunks”. Each “chunk” or routine has a clear beginning, middle, and end. Over time these simple routines can be linked together or expanded into longer more complex routines.

· Care-giving routines: Typically this is the starting point for routines at home and school. They tend to focus on necessary activities the adult must do with the child such as eating, hygiene activities, or dressing activities. Initially the routine is teacher directed but can become more flexible (altered or expanded) as the child becomes familiar with the routine.

· Teacher-directed routines: These are routines developed by the teacher based on knowledge of the student’s preferences, developmental level, sensory needs, and IEP goals/objectives. They are used as a primary way of delivering instructional content. These routines are frequently modified over time (altered or expanded) as the teacher runs the routine with the student and observes the student’s responses to the activity.

· Co-created routines: This type of routine primarily focuses on interaction, bonding and communication / conversation. This results from the teacher responding to an action or interest of the child (“the 3rd thing”) during an interaction. These may appear to be simple games based on hand-play, singing, movements, etc. These routines are very focused on the child’s response and are probably the most flexible in format.

· Many routines begin as teacher-directed routines and evolve into co-created routines as the student is able to participate more fully and begins to initiate actions more spontaneously.

· Independent routines: These are routines most people use to complete the repetitive tasks we associate with living. One of our goals over time is for our student to develop a wide-range of routines he/she can carry out independently or with minimal support.

· The best routines are developed in collaboration with the entire educational team. That way all the IEP goals and objectives can be worked on many times each day in a variety of routines. This helps the student to generalize. Team collaboration also insures that modifications and supports needed by the child are built into each of the routines.

Gathering Information to Create a Routine

· Etiology

· Assessment information

· OT/PT

· Speech

· O&M

· FVE/LMA

· Audiology

· Etc.

· Developmental level

· Infused skills assessment (copy in notes)

· Other assessment tools

· Likes/dislikes

· See form

· Goals/objectives

· Functional

· Based on assessment

· Team approach

· Fun (for teacher and student!)

· Refine what you already do

· Repeat

· Structure

· Focus

· Write it down

· See Form

References:

Hagood, Linda, Communication: A Guide for Teaching Students with Visual and Multiple Impairments, ©1997, TSBVI.

Miles, Barbara and McLetchie, Barbara, 2004. Developing Concepts with Children Who Are Deaf-Blind, D-B Link Publication on the web http://www.nationaldb.org/documents/products/concepts.pdf, 2008.

Smith, Millie, Why Are Routines Worth the Trouble?, http://www.tsbvi.edu/Education/vmi/whyroutines.htm, 2008.

Van Dijk, Jan, 2001. Development Through Relationships: Entering the Social World, NCDB Website, http://nationaldb.org/ISSelectedTopics.php?topicID=69&topicCatID=7#, 2008.

Likes / Dislikes Inventory

Fill one sheet out for each child. Over a period of time through listening to stories from others and through observation of the child, simply list things the child likes and things he doesn’t like. We all enjoy things that we are good at and that we understand. The child’s “Likes” will be his areas of strength and indicates sensory channels that are working. His “Dislikes” will be areas of weakness and indicates sensory channels that may not be working efficiently. The information gathered on this form will give you underlying themes that you can use for modifications, teaching strategies, topics for communication, and activities.

Child’s Name: ________________________

Date: __________

likes

dislikes

Summary Information:

1. What sensory channels is the child using the most?

· Vision for ex. :

· Hearing for ex. :

· Touch for ex. :

· Smell for ex. :

· Taste for ex. :

· Proprioceptive for ex. :

· Vestibular for ex. :

2. What are possible topics for communication?

Units/Themes:

Routines (i.e. joint action/turn-taking; vocational; daily living skills):

3. What are some activities you typically do that the child might find aversive?

4. What other modification, strategies, choice making opportunities are suggested by the above information?

Kate Moss and Jenny Lace TSBVI Deafblind Outreach revised 11-15-06

Activity Routine

Student:

Routine:

Implementers:

Time:

Location:

Materials:_______________

Routine Steps

Adaptation / Modification

IEP Goal Objective/skill

Targeted Vocabulary

Comments & Data

for ____________

Documentation Date: _________

Documenter’s Signature: ________________________

Teacher Notes:

Parent Notes:

Natasha

Etiology:

Natasha was born after a difficult labor on _______, weighing 8 lbs, 7oz. The pregnancy was non-complicated and included prenatal care. She began having seizures at 4 months of age. She had a corpus callosotomy, which severed the fibers that connect the right and hemisphere of her brain, at age 3 to control the seizures. She also had a Vagas Nerve Stimulator (VNS) implant to control seizure activity and help establish normal brain wave patterns. Natasha has been diagnosed with Cortical Visual Impairment (CVI), cognitive delay, and severe sensory impairment.

Assessment Information:

OT/PT: Natasha has many sensory issues, including oral defensiveness. She is resistant to having someone brush her teeth, though doesn’t mind putting a toothbrush in her own mouth. She chews on the toothbrush but does not brush. She is very sensitive to hair brushing. She struggles constantly with organizing her own sensory system. She is very flexible and strong. She uses a raking motion to pick up small items. Occasionally she uses a pincer grasp. This skill is emerging.

Speech: Natasha makes choices by picking an object or by going to the activity area. She shows that she is familiar with objects that represent activity areas by going to the activity area or by protesting. Natasha protests by vocalizing, putting her hand on her hip, dropping, or running away. She also will take a person’s hand and guide them to an area to make a request (especially for food). Within interactions, Natasha will signal for more by moving her body. She engages people socially through eye contact and vocalization, and occasionally by curling up on someone’s lap.

O&M: Natasha is able to avoid obstacles while walking and travels to locations with supervision. She is easily distracted, especially outdoors, and will drop to feel the ground or turn toward various favored items, such as the merry-go-round. She is able to travel to favorite locations within her school building independently, but with supervision. She does not use a cane. She uses visual landmarks to locate familiar areas. She travels independently within familiar rooms.

FVE/LMA: In a low vision evaluation, Natasha was found to have an acuity of 20/400 in both eyes. This is not necessarily an accurate measure of her acuity, the doctor noted, but only the amount of stimulus that she can attend to. No field loss was noted.

Audiology: Natasha was found to have a mild hearing loss, though there is a possibility that she has difficulty with auditory processing. Her auditory responses in functional settings have been inconsistent.

Developmental Level:

Infused Skills Assessment: Level 1

Functional Scheme: 3-6 months in some areas, 6-9 months in most areas. 12-15 months in Gross motor.

LIKES/DISLIKES: See form

Goals/Objectives:

Natasha will. . .

(Daily Living Skills)

Respond to one additional cue in daily living routines by performing the next step.

(Auditory Processing)

Respond to an auditory prompt by turning toward or becoming still in quiet environments.

(Basic Concepts)

Alternate between similar items by comparing tactual, auditory, or visual qualities.

(Social Skills)

Demonstrate awareness of an adult engaging in parallel play by looking at or moving closer to them.

(Communication Skills)

Make a specific request by handing an object to a communication partner.

Likes / Dislikes Inventory

Fill one sheet out for each child. Over a period of time through listening to stories from others and through observation of the child, simply list things the child likes and things he doesn’t like. We all enjoy things that we are good at and that we understand. The child’s “Likes” will be his areas of strength and indicates sensory channels that are working. His “Dislikes” will be areas of weakness and indicates sensory channels that may not be working efficiently. The information gathered on this form will give you underlying themes that you can use for modifications, teaching strategies, topics for communication, and activities.

Child’s Name: __Natasha______________

Date: _2006____

likes

dislikes

Deep pressure/hugs

Hair brushing

Movement/ Proprioceptive input/ Swinging

Being confined/contained/still (unless asleep)

Running

Others putting things in her mouth (toothbrush, spoon, etc.)

Stretching

Wearing shoes

Familiar People (snuggling)

Sitting on toilet

Freedom

Unfamiliar activities

Slippery textures (jello, yogurt, lotion)

Strawberries, Grapes, Black olives, M&Ms

Tickling/raspberries

Being outside

Touching rough surfaces

Shaking her hands/items

Water play

Windows, patterns with holes, bright lights

Banging with open hand

Summary Information:

5. What sensory channels is the child using the most?

· Vision for ex. : Natasha uses her vision for travel and locating objects.

· Hearing for ex. : Natasha is experimenting with using hearing in limited contexts.

· Touch for ex. : Natasha uses her hands to reaching for familiar objects and food and to explore their qualities. She also explores tactually with her mouth.

· Smell for ex. :Unsure.

· Taste for ex. :Natasha puts many things in her mouth.

· Proprioceptive for ex. : Natasha moves and stretches a great deal and enjoys « Row your boat » games 

· Vestibular for ex. :Natasha moves her body constantly.

6. What are possible topics for communication?

Units/Themes:

· Water

· Items to explore with mouth (toothbrush, lollipop)

· Food

· Swinging

· Row your boat

Routines (i.e. joint action/turn-taking; vocational; daily living skills):

Natasha is working on performing her part in daily living routines. Interactive routines during which she can signal to her partner in a variety of ways to control the interaction are most appropriate.

7. What are some activities you typically do that the child might find aversive?

Tooth brushing, hair brushing. Wear shoes. Transitions can take time.

8. What other modification, strategies, choice making opportunities are suggested by the above information?

Natasha requires many breaks. She may not be able to sit and perform a routine in one particular area for a very long time. She must be free to move her body and organize herself the best she can.

Activity Routine

Student:Natasha

Routine:Hygiene

Implementers:Sara & AmyTime: every day, am

Location: in classroom by window (by bathroom)

Materials:_Natasha’s hygiene supplies (kept in red container at her calendar) including: variety of toothbrushes and toothbrush holders, toothpaste, variety of lotions

Routine Steps

Adaptation / Modification

IEP Goal Objective/skill

Targeted Vocabulary

Comments & Data

for ___________

Natasha goes to her calendar and retrieves her hygiene symbol, a red toothbrush, from her “now” basket, a white colander.

Staff places toothbrush in colander, removes other items.

Anticipate hygiene routine.

“Brush teeth” (spoken and signed by staff).

Natasha walks to hygiene area (by window.

Staff assists by picking up symbol and handing it back to N. if she drops it. Staff moves to block visual distractions (ex: swing)

Respond to cue (toothbrush + sign & verbal prompt) by moving toward activity area.

Point to hygiene area.

Natasha assists in removing the lid of hygiene box

Staff starts the process to make it easier to remove.

Practice of fine motor skills using hands.

“Open” spoken by staff.

Natasha chooses an item. (the steps may be out of order here)

Staff makes sure all items are visible.

Choice-making.

Natasha picks toothbrush.

Staff gets out all toothbrushes and places a very small amount of toothpaste on them.

Alternate between similar items by comparing tactual, auditory, or visual qualities.

“Brush”

Natasha plays with toothbrushes.

Staff may retrieve dropped items and present to Natasha by imitating her (shaking).

Demonstrate awareness of an adult engaging in parallel play by looking at/ moving closer to them.

“Brush”

Natasha finishes toothbrushes.

Staff assists by placing some of the toothbrushes in the yellow “finished” basket.

Finishing step/closure.

“Finished”

Natasha picks/plays with lotion.

Staff assists by placing lotion on Natasha’s hands and rubbing/imitating.

Demonstrate awareness of an adult engaging in parallel play by looking at/ moving closer to them.

“Rub”

Natasha finishes lotion.

Staff assists by placing one lotion in finished basket.

Finishing step/closure

“Finished”

Natasha checks hygiene container.

Staff assists by placing container within N.’s line of sight.

Finishing/closure.

“Finished”

Natasha carries symbol to calendar.

Staff assists by picking up toothbrush if Natasha drops it on the way, provides physical block.

Finishing/closure

Natasha finishes object.

Staff assists by placing finished basket near Natasha so that she may place the brush within.

Finishing/closure

Placing item “in” a basket (fine motor)

“Finished”

Documentation Date:_________

Documenter’s Signature: __________________________________

Teacher Notes :

Parent Notes :

Kate Moss and Jenny Lace TSBVI Deafblind Outreach revised 11-15-06

Revised by Sara Kitchen, 11-07

Basic Skills

Infused Skills Assessment

Permission from TSBVI Curriculum Department to reprint this assessment has been granted for use with this TETN. Do no duplicate this material for other use. This assessment is found in:

Evals: Evaluating Visually Impaired Students available from TSBVI at http://www.tsbvi.edu/publications/evals.htm

Evaluation of students with visual impairments is a complex, multi-faceted process of gathering information using appropriate tools & techniques. Informal evaluation should be considered an essential supplement to the use of formal measures and published instruments. In order to determine curricular focus and plan effective instructional programming for students, the staff must know a student's levels of functioning in all areas of academic and unique need. By conducting appropriate evaluations, students' specific needs related to accessing the general curriculum, as well as the areas identified in the Expanded Core Curriculum (ECC) can be identified.

EVALS is a 5-part set which is contained in a convenient file box with a handle and snap tight buckle. It will include:

· Two books of evaluations for the ECC areas

· One book of evaluations for academic subject areas for Practical Academics and Basic Skills students

· Independent Living Skills Assessment and On-going Evaluation

· TAPS Comprehensive Assessment and On-going Evaluation

· Many of the evaluations have been aligned to the Texas Essential Knowledge and Skills (TEKS).

Basic Skills

Infused Skills Assessment

Developed by Texas School for the Blind and Visually Impaired

Student Name:

School Year:

Introduction:

The Basic Skills Infused Skills Assessment is a very effective tool for analyzing the strengths and weaknesses of students with visual impairments who may also have cognitive and behavioral challenges. This assessment begins at a developmentally young, non-verbal skill level, and progresses up to higher cognitive functions, while remaining appropriate for students in life skills programming.

This assessment is divided into different areas: Social Communicative Interactions, Emotional Development, Senses/Motor Skills, Basic Concepts, and Representation and Cognition. Each of these categories has a list of skills arranged in a hierarchy of development from lowest to highest. As you score each skill, you will have four possible choices: three levels of competency in the skill, or that the skill has been generalized.

Typically, as you move through a category, you will find higher scores at the beginning, and then a clear point at which the student ceases to have any degree of competency in the remaining skills. This can be very useful to assist you in your programming and IEP development. Skills from each category that show a low degree or absence of competency make an ideal starting point to develop an IEP. Also, there is some degree of overlap between categories, so that is very possible to have multiple IEP's addressed within a lesson. Scoring the Assessment will give you a numeric value of progress from the time of your pre-test to your post-test.

Pre-test: Have both Assessment and Score Sheet ready. Use black ink.

Each skill is scored once. There are examples for some skill areas, but these are for your clarification only. Feel free to make notes. Score each skill according to these criteria in the

Assessment:

• Student does not demonstrate this skill - leave blank.

• Student does this skill consistently in one routine/environment with a familiar person 50-59% of the time - make one hash mark in "Pre-test Cs" box.

• Student does this consistently in more than one routine/environment with two or more people 60-69% of the time - make two hash marks in "Pre-test Cs" box.

• Student does this consistently in more than two routines/environments with three or more people 70-79% of the time - make three hash marks in "Pre-test Cs" box.

• Student does this consistently in more than four routines with four or more people 80-100% of the time - make three hash marks in "Pre-test Cs" box, and one hash mark in "Pre-Test Gs" box.

As you score each skill, transfer the score to the Score Sheet chart. Locate the corresponding box containing the letter and number for the skill. For one hash mark, you color in one small square within that box. Two hashes, two squares. Three hash marks, three squares. Three hash marks and a generalization mark; color in three squares and mark an X through the entire box.

Complete the assessment:

When you are done, you will have a visual representation of your student. The Score Sheet chart is divided into three horizontal levels representing an increase in complexity and sophistication of communication, from one to three. You should be able to see quickly at which level your student is operating. The Score Sheet is also divided down the middle. The left of the line represents more "people" oriented skills, while the right represents more "object" oriented skills. It may be helpful to your programming to see if one of these areas has fewer scores.

Quantifying competencies and generalizations:

Beginning at the top left corner, box C-1; travel in a vertical line down that column. Add up all the little boxes you have colored in, and write the total in the top "Com" box at the bottom of the column (com = competency). Repeat, adding up all the Xs and record that number in the top "Gen" box at the bottom of the column (gen = generalization). Repeat for each column. When you are finished, add up all the numbers in each "Com" box and total in the Cs Pre-test box at the top of the page. Repeat with the "Gen" boxes and total in the Gs Pre-test box.

Post-test: Have both Assessment and Score Sheet ready. Use red ink.

Repeat all steps of the Pre-test, but this time using a red pen and marking in Post-test Cs and Gs. Mark on the Score Sheet in red ink. In case of regression in a skill area, whiteout previously colored boxes as needed. When adding up the columns, add all squares, both red and black. Record in bottom "Com" and "Gen" boxes at base of column.

Scoring:

The difference between the Pre-test and Post-test scores represent the increase in degrees of competency and generalizations for that student. Dividing the Post-test scores into the Pre-test scores will provide a percentage of increase in skills.

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Sara Kitchen and Chris Montgomery, TSBVI Outreach Consultants - September 2008