Supporting Children who are Blind or have Low Vision Course Aim The aim of this course is to provide you with the tools that will enable you to develop your skill and knowledge in supporting a child who is blind or has low vision. This course will explain how to work with each child's individual needs, provide support to their family and understand how your role is essential to the child's development. Course Objectives Upon completion of this course you should be able to: Course Objectives Upon completion of this course you should be able to: Identify the functional implications of blindness or low vision for a child's development. Identify customized support strategies for children who are blind or have low vision and their families Identify strategies which can be used in the community to support the participation of a child who is blind or has low vision. Introduction This course includes three topic areas: Childhood Development Community Participation Strategies Chapter 1 : Childhood Development Childhood Development Introduction This chapter will outline the physiology of the eye and how vision works as part of the sensory system. This chapter will include information relating to vision and childhood development as well as how a child's needs change over time. Sensory System The sensory system is a part of the nervous system responsible for processing sensory information and allowing you to perceive the world around you. The sensory system consists of three parts: 1. The sensory receptors, a sensory nerve ending that responds to a stimulus in the internal or external environment of a person 2. The neural pathways that act as a conduit of sensory stimuli 3. The brain which enables you to perceive the stimuli. The five main senses are: i. Sight ii. Sound (Auditory) iii. Touch iv. Taste v. Smell Sensory System The senses are transduces connecting the physical world to the part of the mind where we interpret the information, creating our perception of the world. Lets have a quick look at how the eye works with the brain to view an object…. Vision There are three key elements to vision.: 1: an object to view 2: the eye 3: the brain Lets have a look at how vision works…… Vision We will start with a basic object…a tree Vision The eye receives the image of the object as the light rays focus on the retina Vision As the image hits the back of the eye it is flipped vertically. Vision The image is then perceived by the brain and identified as a tree. Visual Processing Visual processing or perception is the cognitive awareness and identification of the external stimuli. Many factors will influence perception. Visual Processing Perception helps us understand and relate to our world. Learning how to understand what we perceive begins in early childhood and is essential to development. Vision develops in newborns with increasing attention to: light, colour, movement, form and detail. Visual development can be promoted by observing what the child is attracted to and then offering lots of opportunities for moving through these stages. E.g. If a child is attracted to objects which catch the light, offer many and varied objects which catch the light, and then begin to offer bold and bright colours. Function of Vision For childhood development vision is……. .. the motivator for many social skills ..the motivator for movement ..the motivator for reaching ..the most dominant sense ..the integrating and organising sense Function of Vision Additionally, the function of vision is to enable: • Motivation to move towards something we see: • we reach, grasp, manipulate and observe objects • this develops fine motor skills • we roll towards people and objects, we crawl, we walk towards objects we see in our environment, we move to where we want to go • Motivation to interact with people • Understanding of the purpose of objects and how they work • Observations of the world and things working around them • Observations of cause and effect for own actions • Development of a body representation/concept of self Blindness in children may result in the risk of: Blindness in children may result in the risk of: Passivity and learned helplessness Uncertainty Purposeful movement limitations Lack of Spatial Awareness • With passivity and not reaching, children who are blind or have low vision can become more interested in their own bodies. • Characteristics such as hand flapping, shaking their head and eye poking can become embedded in their behaviour. • For example children may dislike some physical positions such as the tummy position. This may then affect postural development. • Children with are blind or have low vision like being placed on their back as that is where they feel safe. • This position does not facilitate support positions through arms and the weight shifting required for reaching movements. • A child who is blind or has low vision may have difficulty developing the concept of object permanence and an understanding of space. • Without object permanence, the child is not aware that an object exists when they are not touching or seeing it. • ‘Space is not a place” for a child who is blind or has low vision, it is a nothingness. • A child who is blind or has low vision will need an awareness and understanding of what space is before they will want to move from where they are through it. Function of Vision Children who are blind or with severe low vision may be at risk of delay across all areas of development such as: • Emotion • Communication • Physical • Cognitive • Social • Independence Function of Vision Implications vary according to: • Degree and type of impairment • Age at the time of impairment • Presence of other developmental or learning needs • Childs personality and abilities • Family environment and support • Presence of early diagnosis intervention , support and engagement. Visual Acuity Visual acuity is the ability to see detail. Children are considered to be legally blind when they are unable to see at 6 metres a letter or symbol designed to be seen at 60 metres. In Australia it is expressed as a fraction between 6/6 and 6/60 or less for either near or distance vision. The following images have been simulated to represent normal vision (6/6), moderate low vision (6/24) and legal blindness (6/60) Normal Vision Distance Vision 6/12 6/18 6/24 6/36 6/60 This means that one is able to see at 6 metres a picture designed to be seen at 60 metres Visual Acuity In the kindergarten environment, this means that while children with normal vision can clearly see a toy car on a table from about 6 meters, children who have low vision would need to be as close at 10 centimetres to see it with any clarity. Normal Vision Distance Vision 6/12 6/18 6/24 6/36 6/60 This means that one is able to see at 6 metres a picture designed to be seen at 60 metres Common Eye Conditions Vision impairment may be the result of disease, a birth defect, a genetic condition or may be acquired through misadventure. The following slides depict the vision experienced by those with common eye conditions and disease. Normal Vision Common Eye Conditions Albinism is an inherited condition affecting both eyes. Lack of pigment, either throughout the entire body (oculocutaneous albinism) or only within the eyes (ocular albinism), does not allow vision to fully develop. Albinism Poor vision, nystagmus, need for glasses and sensitivity to glare (photophobia) may be associated with this condition. Common Eye Conditions Cataract is an eye condition where the lens of the eye becomes cloudy and blocks the passage of light to the retina. Cataracts may be congenital (at birth or shortly after) or develop later in life. As the cataract develops, vision gradually becomes blurred and problems with glare may occur. Cataract When the cataract reaches a certain density it can be removed. Common Eye Conditions Hemianopia, or Hemanopsia, is a decreased vision or blindness in half the visual field of one or both eyes, usually on one side of the vertical midline. The most common causes of this damage are stroke, brain tumour, and trauma. Hemianopia Common Eye Conditions Retinitis Pigmentosa (RP) is an inherited, deteriorating condition of the retina. It affects the retina’s rods (photoreceptors) which are responsible for night vision. There is usually progressive loss of peripheral vision but central vision is generally unaffected until the final stages. Retinitis Pigmentosa (RP) RP can cause night blindness and glare sensitivity. Common Eye Conditions Coloboma Coloboma is a congenital condition resulting in the eyeball not completely forming in-utero. It affects different structures of the eye. The severity of vision impairment depends on which structures are affected. This condition can affect one or both eyes and it may be associated with other developmental abnormalities. Cortical Vision Impairment Cortical vision impairment is an umbrella term to describe vision impairment in normal healthy eyes. It is caused by disruption to the parts of the brain which control vision. This often results in variable visual responses. Nystagmus Nystagmus is continual, involuntary, fine movement of both eyes. It can be present by itself but is commonly associated with other eye conditions that cause blurred vision. Children often instinctively adopt a head posture so the eyes are in a position where there is less movement. This position is known as the null point. Poor health and fatigue can make the nystagmus more pronounced thereby reducing vision further. Optic Nerve Hypoplasia Optic Nerve Hypoplasia is caused when the optic nerve, responsible for transmitting visual signals from the retina to the brain, is not fully developed thereby passing less information from the retina to the brain. It may coexist with other conditions such as septo-optic dysplasia. Common Eye Conditions Retinal Dystrophy Retinal Dystrophy is a generic term indicating abnormality of the retina. The extent of vision loss from retinal dystrophy can vary dramatically and is dependent on which area of the retina is affected. Examples of retinal dystrophy are Leber’s Congenital Amaurosis, which can cause blindness or near-blindness and Achromatopsia which can cause absence of colour vision and extreme sensitivity to light. Retinoblastoma Retinoblastoma is a malignant tumour of the eye usually occurring before five years of age. The tumour may affect one or both eyes and is usually hereditary. Laser and radiation treatment may be used to try and save the eye and prevent the spread of cancer cells into other parts of the body. If unsuccessful, the affected eye is removed (referred to as enucleation). Retinopathy of Prematurity (ROP) ROP is a condition affecting premature babies. It occurs when abnormal blood vessels grow in an area of the retina where normal vessels have not yet grown. The new blood vessels may cause retinal scaring which result in vision loss. In severe cases, detachment of the retina can occur. Laser therapy can help if diagnosis and intervention occur early. Microphthalmia Microphthalmia is a genetic abnormality where the eyeball is significantly smaller than normal. The condition is present from birth and does not improve with age. This condition can affect one or both eyes and is commonly associated with other eye conditions. Impact of Vision Impairment on Development The benefits of early intervention Impact of Vision Impairment on Development The benefits of early intervention Learning starts from birth (Shonkoff & Phillips, 2000), and skills develop cumulatively, so that those acquired early form the basis for later skill development (Cunha et al., 2006). Impact of Vision Impairment on Development The benefits of early intervention Thus, the skills children develop in the early years contribute to a chain of effects that either reinforces and amplifies their initial skills and dispositions, or exacerbate initial difficulties and even produces new ones (Rigney, 2010; Stipek, 2001, 2005; The Marmot Review, 2010). Impact of Vision Impairment on Development The benefits of early intervention Children need multiple opportunities to practice functional skills in everyday environments. Impact of Vision Impairment on Development The benefits of early intervention Because children’s learning is cumulative, early functioning is predictive of later functioning however, behaviour and functioning at any point in time are also more strongly influenced by the immediate social and physical environment than by past experience. (Feinstein & Bynner, 2004; Lewis, 1997, 2005. Macmillan et al., 2004; van Jzendoorn & Juffer, 2006). Source: Moore, T.G. (2012). Rethinking early childhood intervention services: Implications for policy and practice. Pauline McGregor Memorial Address presented at the 10th Biennial National Conference of Early Childhood Intervention Australia, and the 1st AsiaPacific Early Childhood Intervention Conference, Perth, Western Australia, 9th August . Impact of Vision Impairment on Development It is useful to note the following when working with children: • up to 80% of learning is gained through vision integrated with other senses • approximately 65% of the population are visual learners • the brain processes visual information 60,000 times faster than text • 90% of information coming to the brain is visual • 40% of all nerve fibres connected to the brain are linked to the retina • visual aids in the classroom improve learning by up to 400%. Source: Alabama Institute for Deaf and Blind, www.aidb.org, 21/5/2012 The above statistics indicate the significant impact limited vision can have on a child's ability to understand concepts, learn language, move about with confidence, and develop and grow in a variety of ways. Impact of Vision Impairment on Development Many factors can affect the way a family cares for their child, responds to their vision impairment and accepts assistance from external service providers. These may include: Family Background Individual and families’ understanding and acknowledgement of vision impairment. Social networks and community connections Communication style of the parents and family Family support Impact of Vision Impairment on Development The basis of Vision Australia’s family-centred practice is awareness and sensitivity. Recognising individual difference and supporting each family’s needs are essential to this approach. When staff listen to individual family’s priorities, positive outcomes are more likely. There may be many other people involved in the child’s life. So in addition to working with the child who is blind or has low vision, it is important to consider the whole family: parents, carers, siblings, grandparents and extended family members. For some families this may be many people. Checkpoint 1 Vision is important to childhood development as it develops….(Choose all correct responses.) 1. 2. 3. 4. Understanding of the purpose of objects and how they work. Observations of the world and things working around them. Greater development of other senses such as hearing. Development of a body representation/concept of self. Answers 1, 2 and 4 are correct Checkpoint 2 Which elements of a child's family situation are important to development? 1. 2. 3. 4. Family background. Communication style. Social networks. All of the above. Answer 4, All of the above is correct. Checkpoint 3 When is the optimal time to start support for a child? 1. 2. 3. 4. When they start school. When they have begun to respond to sounds and touch. When are old enough to wear glasses. None of the above. Answer 4 is correct, children should start intervention immediately, early intervention is important to development. Chapter 2 : Strategies Strategies Introduction The role of service providers is to help parents understand their child’s unique mode of learning in order to assist their overall development. It is crucial everyone working with the family has accurate information about the child’s functional vision, what they can and cannot see, and how they use this vision for practical everyday activities. Some carers may not know what to look for, disregarding the child’s vision impairment, as they appear to be functioning well. This may lead to them thinking the child’s vision impairment has little or no impact on everyday life. This chapter will outline strategies you can use when caring for children who are blind or have low vision. Strategies When working with children who are blind or have low vision, you may need to develop strategies to check and test the child’s understanding of their vision impairment and the functional implications. A functional assessment to assist you to understand what the child can and cannot see is a good start. This is important as you may observe and conclude that some children are functioning well, however they may need additional support. Children who are blind or have low vision need to be given time, space and encouragement with realistic expectations and consequences. Feedback and praise is vital but staff and carers must be mindful this is not overdone as it can set up an unrealistic view of life for a child and their family. Attempts to overprotect children from harm may also teach them they are helpless, i.e. learned helplessness. Strategies As the child grows and matures, they develop their own way of managing with their eye condition. This will vary across individuals, age groups and eye conditions. They can only tell you from their perspective what they see. If they do not have anything to contrast their vision against, then they cannot be expected to understand and communicate the full impact of their impairment. Most young children function quite well within a familiar environment. Some parents may not understand the full impact of their child’s vision impairment because they mostly interact with them at home where the child is moving within a familiar environment. The implications of the child’s vision impairment may only start to become noticeable when they venture away from home and start to move around in unfamiliar environments. This will be evident when younger children go to childcare or kindergarten or when older children transition to school or community and social groups and activities Strategies Strategies Strategies Strategies Strategies Strategies Strategies All children learn by their experiences, good and bad, and children who are blind or have low vision will benefit from being encouraged to develop self-confidence, a strong ego, a desire to explore and feelings of success. When you model positive behaviour in the way you relate to the child it will encourage others to do the same. Strategies Children learn about themselves and their environment by active movement and exploration. Active learning through active participation helps to develop object permanence, spatial awareness, body awareness and active purposeful movements. It is important to create a developmentally appropriate environment for the child and encourage motor, cognitive and communication skills. Strategies In ‘Skills for Success’, Dr Karen Wolffe lists five critical aspects to consider when working with young people: Encourage socialisation Encourage development of compensatory skills Provide realistic feedback – Avoid unwarranted praise Convey high expectations – Don’t over-protect Promote opportunities to work Source: Wolffe, K.E. (Ed). (1999). Skills for success: A career education handbook for children and adolescents with visual impairments. New York: AFB Press. Strategies Hands off “to hold a blind child’s hands effectively blindfolds them” Change to a Be careful that when we facilitate movements consideration for the child we are not encouraging learned helplessness and passivity. To empower children towards independence an object should be brought to the child, rather than the child’s hand taken to the object. Source: Nielsen, L (1990). Are you blind? Copenhagen: SIKON. The child experiences the sensations of the adult’s hands rather than their own sensory experiences. Considerations – Low Vision Visual and physical fatigue Short periods requiring concentrated visual attention interspersed with a less taxing activity will assist a child to remain on task when required. Considerations – Low Vision Reduction of glare Looking into the light can be uncomfortable and impact on a child’s vision. It is important to provide adequate light but be aware of excess glare form windows or wet surfaces and off table tops or floor surfaces. It is important for a child to be seated with their back to a window, so their level of vision is not compromised by the interference of glare. A child may need more time to adjust when moving between locations where there are differing levels of lighting such as moving from outside to inside. The picture above of 2 children facing the window shows a situation where there is high glare from the open window. It would be best to close the curtains and remove the glare or have the children face the other way. Considerations – Low Vision High contrast Objects presented on a high contrast background are easier to see. For example, bright toys on a white surface as opposed to white objects on a white surface. The picture above of food in a white bowl on a white table shows a low contrast table setting as viewed with vision impairment. The white bowl blends into the white table top, however the brightly coloured jelly beans provide good contrast. A black background can be used to provide high contrast. Contrast can be provided on steps and stairs and used to mark obstacles such as poles. Considerations – Low Vision Facial expressions It is difficult for a child with low vision to see and understand facial expressions and slight gestures, particularly at a distance. It is important for a person interacting with a child to move close to them when talking. If communicating from a distance, use clear language and not facial expression alone. Considerations – Low Vision Time Children may need extra time to absorb information and to physically move around to find information. Considerations – Low Vision Normal vision with a high clutter / low contrast background Clutter It is easier to locate people, objects, or pictures in a book if the background is not too busy or cluttered. Profound vision impairment with a high clutter / low contrast background Objects which are simple, singular, bold and bright are more easily seen. Literacy and Learning Braille and adaptive technology Braille is the medium by which children who are unable to access print can efficiently learn to read, write and communicate. “With a tactile medium such as braille comes literacy, spelling, writing, and broad communication possibilities are open and available. With literacy comes the possibility of freedom. With freedom comes the possibility of endless achievement from pleasant living to significant social contributions.” Source: Clyke, F.K. (2001). Braille into the next Millennium (an anthology) from National Library Service for the Blind and Physically Handicapped Individuals in North America, Washington DC, Foreward. Literacy and Learning Braille and adaptive technology Feelix Library is a library of book kits produced in braille, print and audio. Feelix exposes children and their families to braille and tactile formats at a very early age, to open the world of possibilities for children who are blind or have low vision. It shows families how their children will learn as it exposes children to language rhythm and patterns that will encourage them to love books and being read to. When children start school they should be on a level playing field with their sighted peers. Feelix works to make this happen for children who are blind or have low vision. Literacy and Learning Technology plays a key role in learning and is always evolving. Some of the reading and writing tools available to children who are blind or have low vision include: • • • • • Enlarged print Magnification such as hand held magnifiers, CCTV’s (Closed Circuit Television) Smart phones and tablets Screen enlargement and screen readers Braille writers and transcriptions Working with Children 0 to 6 Parents are their child's first teacher and guide their early understanding of the world. They know what their baby needs when they cry, what specific facial expressions mean and what makes them happy, anxious, fearful or confident. Encouraging parents to offer their unique perspective will empower them to support their child’s growth and development. Children learn through play. This is no different for a baby or child who is blind or has low vision. Any activity that provides the child with sensory experiences involving touch, sound, smell and taste assists them to make sense of their world. Working with Children 0 to 6 When interacting with infants and young children who are blind or have low vision: • say the child’s name to gain their attention • introduce yourself • use clear and precise language • understand they may tire sooner than other children • tell them when you are leaving. Working with Children 0 to 6 Allow the child: • time to get used to you being near them • time to listen to your voice and prepare for your interaction • time to respond - without visual stimulation more time is required to process what is happening around them • extra time to complete a task, locate and identify materials, and to integrate information from their other senses • to learn skills that are meaningful to them • to learn new skills step by step • time to practice and repeat - skills develop when they are repeated and practiced frequently • the freedom to accept or reject an object rather than having it forced upon them Working with Children 0 to 6 “When Veronica was asked to nod, she put one hand on one side of her head, and tilted it back and forth. This was her experience of nodding with an adult doing the action to her. Given the opportunity to feel an adult nodding, she understood and repeated the action.” Source: Haughton, L. and Mackevicius, S. (2001). I’m Posting the Pebbles, RVIB. Working with Children 6 to 12 During this life stage children continue to build on the experiential learning gained in early childhood. Life, social and motor skills continue to develop as the child spends more time undertaking structured school activities and interacting in the community. Working with Children 6 to 12 When working with primary school aged children who are blind or have low vision encourage them to develop independent life skills by promoting: • self-confidence and resilience • socially appropriate behaviours by encouraging participation in after school programs and groups such as Guides, Scouts, youth and kids clubs • friendships and social interaction with other children by encouraging parents to organise for other children to visit • negotiation, communication and problem solving skills • appropriate skills for personal hygiene, self-care and wellbeing • improved motor skills by participating in recreation and social groups Working with Children 6 to 12 • organisational strategies for school life such as looking after their schoolbag, lunch box, dressing for swimming/sport • appropriate communication and social interaction – lifting their head, facing toward person they are speaking to and shaking hands where appropriate • appropriate communication strategies to teach what is in and out of context • awareness of their individual strengths and differences • improved mobility and spatial awareness to safely and confidently access their environment: stairs, outdoor equipment, getting to and from the classroom and playground • mastery of new and existing technology • work and career awareness Working with Children 6 to 12 In a recent group session one child commented that it was “so nice to be doing the same task as everyone else”. Source: Vision Australia employee, October 2013. Working with Children 12 to 18 Young people learn through engaging with the world. There is a vast contrast between primary and secondary school. Some families find this move daunting and feel anxious about how they and their child will cope. It is often more difficult to coordinate all relevant staff at this stage and families can feel disconnected even though secondary schools run regular meetings to update them on how their child’s individual needs are being addressed. There is also a significant shift in the decision making process; the family is still central but the young person is encouraged to have greater control over the decisions that affect their life. Working with Children 12 to 18 When interacting with secondary school children who are blind or have low vision encourage them to: • work toward greater independence • participate in recreation activities • undertake reproductive and sexual health education • work toward career and work readiness • assist with self-advocacy Working with Children 12 to 18 “What you do with them today, when they are two, three, four, five or six or sixteen years of age, will determine what they will do at age twenty-four, thirty-four or forty-four. You are raising adults ”. Source: Dr Phil McGraw 2004:11 (television program). How can I help? Vision impairment has a significant impact on the amount and quality of visual information that a child receives. Consequently a child’s development, education and socialisation may be affected in various ways and may cause developmental delay and isolation. The following strategies could be considered both in the home or when planning educational programs. • Provide maximum contrast between objects and backgrounds using bright plain colours. • Reduce glare with curtains and blinds and ensure the child's back is to the window. • Notice clutter and pattern. It may be difficult to locate people and objects if the background is busy. • Provide time for children to look closely at objects and people, and to touch and explore so they can add to their visual knowledge. Provide sensory experiences touch, kinaesthetic and vestibular. How can I help? • Allow extra time - a child who is blind or has low vision will require more time to complete tasks. • Allow for repetition. • Use the child’s name at the beginning of your interaction to gain their attention. Tell the child who you are. • Be specific with your instructions and explanations. • Be aware of the effects of visual and physical fatigue on the child. Checkpoint 4 Which of the following strategies are best practice when working with children who are blind or have low vision? (Choose two responses.) 1. 2. 3. 4. Providing extra time for them to learn Completing the task for them so they keep up with others in class Offering lavish praise Allowing them the opportunity to reject or accept an object Answers one and four are correct. You should always allow extra time and not complete tasks for children. Praise should be appropriate and the same as offered to other children of that age group. Checkpoint 5 Assume the following image is your office or classroom, what would you change to support a child with low vision? (Choose two responses.) 1. Nothing, it is a typical classroom 2. Remove clutter 3. Place the child at the red desk to create contrast against books 4. Change the curtains Answers two and three are correct. Remove clutter from the wall and around the room to create clear definition and high contrast, place the child at the red desk in order to create a contrast against the white pages of a book. Checkpoint 6 Complete the following sentence. When providing care or support it is important to… (Choose one response.) 1. 2. 3. 4. Have high expectations Provide clear instructions and repeat if necessary Discourage inappropriate behaviours All of the above All of the above (4) is correct, do not be afraid to have high expectations of a child or to discourage inappropriate behaviours. Chapter 3 : Community Participation Community Participation Introduction Inclusion involves embracing human diversity and welcoming all children and adults as equal members of a community. It Involves valuing and supporting the full participation of all people, recognizing and upholding the rights of all, and understanding human diversity as a rich resource and an everyday part of all human environments and interactions. It is an approach that is free from discriminatory beliefs, attitudes and practices. Community Participation Through active involvement within the community both the individual and community benefit as an outcome. It is important to have a commitment to meaningful participation of those who are blind or have low vision. Meaningful participation involves more than being present; it involves promoting engagement in play and activities. Participation is more than being present in different environments. The person must be actively engaged and their involvement must be more than tokenistic. For participation to be meaningful, the person’s role and contribution must be valued by all those involved in the activity, including the person themselves. The reason we want children to be meaningful participants in everyday environments is because meaningful participation is the engine of development and the key to attaining a true sense of belonging and a satisfactory quality of life. Community Participation Most community programmes do not need to be modified significantly to accommodate the needs of a child who is blind or has low vision. Community Participation Take a break from this course….. Take a few minutes to look around the room or office, get a drink and walk around. Consider while you do this….. • How would you accommodate the needs of a child who is blind or has low vision? • What would you change? • How would these changes benefit your current space? • What action can you take today to ensure inclusion? Please return within 10 minutes Community Participation You should have come up with a few ideas! If possible write them down and schedule time to action these. Your ideas may benefit everyone. Community Participation It is important to recommend support that is customized to the child's needs. Consider what type of intervention you could recommend to assist the child and support their participation within the community. These may include: • • • • • Attending swimming classes Joining a social group such as Scouts or dance classes Meeting with other providers such as physiotherapists Learning to play a musical instrument Recommending specific play time at home that involves the introduction of new objects, activities or playmates Think of a few others and create your own list Community Participation • For additional support there are many specialist vision agencies with relevant information. Please contact a vision specialist agency in your local area. • Vision Australia may be contacted on 1300 847 466. Summary Congratulations! You have completed this course. This course has provided you with the tools that will enable you to develop your skill and knowledge in supporting a child who is blind or has low vision. Following this session take a few minutes to consider your plan for assisting with children and families of children who are blind or have low vision, and develop some action points that you can apply during their next visit. Ensure you understand that your role is essential to the child's development.
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