Training in CVI should not be optional

From Cortical Visual Impairment, An Approach to Assessment and Intervention, by Christine Roman-Lantzy.

A while ago, the Chicago Tribune published an article, Programs for visually impaired students face teacher shortage, describing the nation wide shortage of vision teachers to serve students who are blind or visually impaired. Any parent of a child who is visually impaired can attest to the shortage of teachers of the visually impaired (TVIs), and orientation and mobility specialists (O&Ms). But the author missed the bigger story. As any parent of a child with cortical visual impairment (CVI) can tell you, it is almost impossible to find a TVI who is proficient in CVI. Our children with CVI, who often comprise half or more of a TVI’s caseload, are overlooked and poorly served.

Multiple sources, including the American Printing House’s (APH) Statement on Cortical Visual Impairment, confirm that CVI is the leading cause of visual impairment in children in the US, and abroad. Its prevalence in developing countries will eventually increase too. But most people have either not heard of CVI, or have limited knowledge of it. Since my son’s diagnosis in 2011 of “cortical blindness” at one week old, I have explained CVI to early interventionists, neurologists, occupational therapists, ophthalmologists, orientation and mobility specialists, pediatricians, physical therapists, special educators, speech language pathologists, and teachers of the visually impaired. I have endlessly explained my son. I have endlessly responded to the question, “What does your child see?”

It is a similar experience for parents all over the country. Over and over, the same story, My child’s TVI does not understand CVI. My child’s TVI does not know what to do for my child who has CVI. My child’s TVI does not know the CVI Range, or how to plan CVI interventions, or how to write appropriate IEP goals. How in the world can this vast lack of knowledge exist when CVI is the leading cause of visual impairment in our kids?

This crisis exists because TVIs do not learn about CVI in their graduate level teacher preparation programs across the country. These programs are still weighted toward teaching about ocular visual impairment. The focus is on assessments such as the Functional Vision Assessment (FVA) and supports for students with ocular conditions. There is a strong emphasis on braille. But the FVA and Braille are inappropriate when it comes to supporting my son who has CVI, and most students with CVI. Right now the only vision assessment we have for students with CVI is The CVI Range (Roman-Lantzy). The CVI Range is not the only assessment – but it is the only assessment that is specific to children with CVI. Interventions for children with CVI look different, with an emphasis on building and using vision. Supports for students with ocular impairments, which emphasize tactile learning (think braille) are inappropriate for children who have CVI (Roman-Lantzy). A TVI friend described the amount of time dedicated to studying CVI in her two year vision studies program as equivalent to “an afternoon lecture.”

Currently one vision program in the country teaches cortical/cerebral visual impairment and the course is required, not optional. UMass Boston has taught CVI for several years, and eventually made their CVI course and learning about CVI mandatory. Ellen Mazel, author of the CVI Teacher blog, teaches that course.

Perkins School for the Blind offers a host of both onsite and online continuing education courses in cortical visual impairment. In addition, they offer the Perkins-Roman CVI Range Endorsement. The Endorsement recognizes TVIs who are proficient in CVI, and helps reassure parents that the TVI working with their child understands CVI, understands their child, and understands how the child sees. Yes, continuing education is important, especially when it comes to the brain and neuroscience. But  training in cortical visual impairment remains “optional” for teachers of the visually impaired and orientation and mobility specialists.

It has been several years since my son’s stroke, and my first time hearing the words cortical visual impairment. My son’s diagnosis of CVI was not optional. TVI training in cortical visual impairment cannot be optional.

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