CVI TVI VISSIT
Hello, and welcome to CVI for the TVI and other professionals, our monthly presentation and discussion around the topic of CVI. My name is Yvonne Locke, and I will be the moderator for today's presentation, which will begin in just a moment. On today's webinar, we are talking about determining service levels for learners with CVI using the Visual Impairment Scale of Service Intensity, known as VISSIT with Dr. Shannon Darst of Steven at Austin State University of Texas. The VISSIT is a research based tool developed to help TVIs determine the appropriate type and amount of service for students with visual impairment.
During today's webinar, Dr. Darst will focus on using this tool for buyers with CVI. Perkins Learning Webinars are presented throughout the year on a monthly basis. You may registered to attend live at no fee or view recorded webinars at a time and place that suits your schedule. The webinar series is just one of the offerings in our professional development program, which includes publications, e-newsletters, webcasts, online and in-person classes, and self-based study. You can see our entire listings at our website perkinselearning.org
Before we get started, I'd like to review a couple of things about the technology. To keep noise levels in control, we have muted your lines. A question and answer space will be provided on the screen shortly, and we will encourage you to post your questions as they occur to you during the webinar. We will be taking your questions at the end of the presentation. We are using this virtual meeting room for audio. Make sure your volume is on and turned up. External speakers or personal headphones give the best audio.
You do have individual controls for your screen for both audio and video. This part of the introduction is to give you time to make adjustments as you need. Audio and video may not be in sync. Wireless connections can be particularly troubling. Usually, the connection correct itself. And unfortunately, it's outside of our control. If the delay is distracting you, you can hide the video pod.
This event will be recorded and available tomorrow on the Perkins website, including a PDF version of the slide presentation. Thank you for joining us for this event we appreciate your feedback and your topic suggestions. And now it's my pleasure to introduce today's speaker. Dr. Shannon D. Darst is an assistant professor in the visual impairment preparation program at Stephen F Austin State University Texas and an adjunct professor and intern coordinator for the Texas Teacher of Students with Visual Impairments Preparation program at Texas Tech University, Texas.
Dr. Darst worked in both a residential setting and in the itinerant service model for students with visual impairments for 20 years in the central Texas area before moving into full time work in TBI personal preparation. Dr. Darst says a board member of the Texas Association for Education and Rehabilitation of the Blind and Visually Impaired and serves as a member of the subcommittee of the Texas Action Committee for the Education of Students with Visual Impairments, which developed VISSIT and the O&M VISSIT, Visual Impairment Scale of Service Intensity of Texas the Service Intensity Recommendation Tools. And with that, I'll give you Dr. Darst.
Good afternoon, everybody. Thank you for coming to this session about the VISSIT. I'm going to go ahead and share my screen. And so everybody should be able to see the PowerPoint once I do that. All right. So we're going to talk today about the Visual Impairment Scale of Service Intensity of Texas, otherwise known as the VISSIT. I'm going to go ahead and just give a brief introduction about what the VISSIT is and what it's for.
The Visual Impairment Scale of Service Intensity of Texas is designed to guide teachers of students with visual impairments in determining the type and amount of itinerant TVI services to recommend for students on their caseload. The Individualized Education Program committee will typically rely upon the TBI for recommendations of this sort. The scale actually supports the TVI in quantifying information for the IEP committee. it is hoped that the VISSIT will provide guidance so that all students with visual impairment to get the benefit of an appropriate amount and type of VI service.
The major components of the VISSIT, the things that kind of set it apart from other service intensity scales are twofold. The VISSIT signifies direct intervention and collaborative consultation services. And so those are two recommendations that come out of the VISSIT once it's completed.
And the second is that the VISSIT is focused on student need only. The VISSIT was created to show student need and all of the ECC areas, as that is what we as TVIs focus on. Rather than talking about workload or caseload need, we're talking about focusing on just a single student need in each of the ECC areas.
I'm going to go ahead and show you what the VISSIT looks like. This tool has been validated and reliability tested. So everything that's included on here has validity has reliability. So it can be used with all types of students from birth through age 21. We designed this to be used with students in an educational setting.
And we designed this to be used for students with all different kinds of visual impairments, everything from low vision to CVI, no light perception, deaf blindness. This tool works with all students. And today when we go through, I'm going to do a little case study/practice completion of the VISSIT We're going to focus on a student with CVI so that we can see how the VISSIT works with a student with visual impairment and namely CVI.
So basically, the tool it's set up in this manner, if you'll direct your eyes to the screen. And I'll describe it for those who can't see. On the left hand side, we have basically all the ECC skill areas. All nine of the areas are designated on the VISSIT. Some of those areas are broken out into other more focused topics to give more weight to the scoring.
And so this first page, for example, the ECC skill area of compensatory skills is broken down into literacy instruction, organization and study skills, and communication modes. And of course, it goes on to the next page and the subsequent pages. And all of the ECC skill areas are included. Again, some are broken out into more focused areas, and some are just a skill area by themselves.
The second column on the VISSIT is designated for the scoring for direct instruction from a TBI. And these ranges, these numbers on here designate the amount of student need. And these numbers, I have to say that you have to enter these specific numbers, you can't deviate. So the range of numbers is the 0, 1, 4, 7, 10. And each of those numbers has a definition related to student needs.
So for instance, 0 means no need at this time. A 1 means low need, occasional support and/or maintenance of skills. A 4 means medium need. That means they have need in that skill area, but those skills are low priority. It could also be used for generalization and fluency development. So it can mean a couple of different things. 7 is a high need. That means that those needs are priority or the student needs to work on complete mastery of introduced skills, so a lot more intensity going on there.
And then 10 is intensely, high priority, acquisition of new skills. And that could be something for instance, you might have a student who has had a traumatic accident where they lost all their vision all at once. There could be a lot of 10's in those areas. So that is how the direct instruction time is scored. And then the third column on the VISSIT talks about the educational team support and collaborative consultation.
Our committee felt very strongly that we needed to designate both sets of times. In some places, some states, some districts, TVIs eyes are actually allowed or encouraged to designate direct service time and collaborative consultation times separately on an IEP scheduled of service minutes. Sometimes people are encouraged to combine those two. But in any case, we wanted to make sure that both types, service time direct and collaborate consultation, were measured on this tool, because we feel like both types are very important for all the students that we serve.
So again, those ranges for scoring under the collaborate consultation time, again, same number system 0, 1, 4, 7, 10. But these definitions relate more to the collaboration piece rather than the direct instruction. 0, no need at this time. 1, low need, teacher, family, team needs infrequent support for established routines, IEP goals and objectives, or modeling of curriculum.
4 is a medium need. Teacher, family, and team needs some support for development and maintenance of routines, goals, and objectives, modeling and curriculum. 7 is high need. So teacher, family, and team needs ongoing support for established routines, implementation of IEP goals and objectives, or modeling a curriculum. And 10 is that intense need. Teacher, family, and team needs ongoing support to establish new routines, implement IEP goals and objectives, modeling and use of curricula. So basically, the scoring ranges for direct and collaborative consultation carry through the entire VISSIT tool.
There are a few pages that-- again, we're covering all the ECC areas. And this is the final page of the actual tool where you put in your score in for student need. Again, student need is always based on the evaluation. So we do the evaluation first, and then we complete the VISSIT. So I'm going to say that one more time. The evaluation on the student is completed first, and then the VISSIT is completed based on evaluation data, because this tool is saying, here's what the student's needs in all the ECC areas.
Here's how we're going to prioritize them, and here's how much time goes with those needs. And again, same deal on the left hand side, that first column, we're still talking about the ECC skill area. And you can see the last one on here, self-determination, it's in a box by itself. It wasn't broken out. So it's weighted only by itself.
Underneath that where we start talking about columns subtotals, there's going to be a couple of things that we had to add called contributing factors. So the idea behind a contributing factor is that all of the student need-- and that includes their visual functioning and acuities, their cognitive development, any other kinds of behavior issues, learning media-- all of the needs are going to be encompassed in your evaluation. We trust that TVIs can do really thorough, detailed, and comprehensive functional vision evaluations, learning media assessments, and ECC summaries.
What we are taking to the VISSIT is all of that data and saying, student need based on the evaluation is this in all of these need areas. We found that two factors could not be accounted for in typical evaluation data. Those two factors are transition and medical status or condition.
And what we mean by that is transition could be from placement to placement. A child who's in early childhood intervention is going to be in the home and they're now turning 3, and so they're going to move into a preschool or PPCD setting. A child's going from elementary to middle school. We have a young person graduating and moving into college or work or adult life settings. A transition can also be from one school to a different school, from one district to another district.
Transition could also include moving one state to another. It doesn't necessarily just have to be about educational placement. It could be about physical placement as well. Anytime that there's any kind of transition, that's not necessarily going to be accounted for in the evaluation. So we wanted to make sure that there was some way to weight transition. And we added a contributing factor line for that.
The second contributing factor that we wanted to add was medical status or condition. Medical status or condition, again, is not necessarily going to be seen in the evaluation data. And what we mean by that is a medical status or condition, there may be a student who has a severe illness or a disease that requires hospitalization. In that case, you as the TVI may have to adjust how much time that you would recommend seeing this student, knowing that the student may be hospitalized for lengthy periods of time or that the student won't be able to attend school but won't be basically put on a homebound placement. They may miss a lot of days for medical appointments or other types of medical related conditions. So we wanted to give everyone the opportunity to factor that into the amount of time that they recommended.
And then we have a third separate area that only is going to be accounted for in the collaborative consultations section. And that's called the Additional Areas of Family Support. We have a separate little chart to account for that. But again, those are some factors that would only be related to working, say, with a family or guardians or caregivers that also would not be accounted for in the actual evaluation, the functional vision of the LMA/ECC.
The 0 1 4, 7, 10-- and 0. Is everybody's still able to hear me? I'm sorry, my internet seems to be a little shaky. 0 1 4, 7, 10 is the range of scoring. And the areas of family need that would not be reflected necessarily in the students evaluation-- consistency of educational concepts across school and home settings, connecting family members to outside agencies and support services, facilitating active family participation in special ed meetings and medical visits, assistance in overcoming cultural or language differences, and strategies to support family and bonding and interactions with their child. Again, some of those things, especially with families with infants and toddlers or newly diagnosed visual impairments at whatever age or families who are new to your community or new to your area, we want to be able to give the TVI an opportunity to give some weight to the time that they are recommending, using this table.
So once you fill out the entire VISSIT tool and the Family Support Table, the beautiful thing about our VISSIT, you can do the visit by hand if you really love your math and your handwritten work. But if you use the electronic version, the VISSIT will self-calculate, which makes all of those calculations nice and easy for those who are not mathy. And what happens is-- oh, let me back it up real quick, a second.
These boxes will all become populated. And what will happen is down here-- and I went back to the final page of the VISSIT-- the very last line will give the total number, which basically is defined as the student need. That will be the total number of student need for the Direct Instruction column and total number of student need related to collaborative consultation. Those numbers will self-populate there on that final page of the VISSIT.
And once those totals self populate there, they will also pop in to the Recommended Schedule of Service Minutes. The Direct Service Time, we have a sheet that is for direct service time and for collaborative consultation. I'm going to kind of describe a little bit for those of you who might not be able to see this what that Recommended Schedule of Service Minutes Direct Service Time form looks like.
On the left hand side, it gives the score from the rubric, which is that total from the direct instruction column. The second piece on this form is the suggested service time. And these ranges again, these were statistically calculated. So they're weighted based on statistical values. And then the third column on this form is the Total Direct Service column.
And that's what the total from the bottom line of the tool pops right into this column, wherever it belongs. And then that fourth column, recommended amount of service, that's how much time you recommend. And again, we're going to go through this so you can kind of understand what it is I'm saying. You'll have a visual of it.
And then also on this page, there is an explanation and justification for your recommended service time. So let's say that you end up having 60 minutes a week as the recommended amount of time for a student based on that student's need, but you don't want to have a whole hour of a lesson.
So down here on this first explanation, you can write in 30 minutes two times per week with this student. And that will fit into the 60 minutes a week service time that you've recommended. And you can break it up however you would like.
And the second part of that, there is a little blank here that says, if recommended service time as indicated by the VISSIT does not match the IEP team's decided amount of service, please state the factors or the reasons why there's a discrepancy.
And so what that means is, for instance, let's say you have a student who is in full academic classes, pre-AP or AP classes. They have a huge workload. And really and truly, they're not able to be pulled out of any of those classes for VI service of this time. You could say, I would like to work with this student three times a week for 45 minutes each time, but the student doesn't have any time to be pulled out, and the family and the student have basically declined having any of that direct service time, and that's why. So you would write that at the bottom.
The collaborative consultation team support collaborative service time, the form looks the same. The ranges are slightly different, but it works the same way as the direct service time with the total from the tool popping in here, and then the amount of service time you want to recommend for collaborative consultation. Same deal at the bottom with the explanation and justification of the recommended amount of service time.
OK. So I'm going to go ahead and talk a little bit about some frequently asked questions. And again, I'm going to show you in just a few minutes what the VISSIT website looks like. You can find all of this information on the VISSIT website, but I wanted to go over it for those of you who are auditory learners.
So can the VISSIT be used for all students on my caseload, including those with multiple impairments and/or those with deafblindness? What about infants? So the VISSIT was designed to determine the appropriate type and amount of service for all students with visual impairments on the TVI caseload. So just to reiterate, the VISSIT can be used and should be used to determine service time, both direct and collaborate consultation with students with CVI after the evaluation is done.
Is the VISSIT to be used as a caseload or workload analysis tool? Absolutely not. As you noticed, there was no blanks in there for travel time, or materials prep, or any of that. That is not included here. The VISSIT is only to be used to determine student need in all the areas of ECC skill training. Like, they need to learn ECC skills, and that need is based on the student evaluation only.
Can professionals who are not teachers of students with visual impairments fill out the VISSIT? We highly recommend in order for the tool to remain valid and reliable that the VISSIT must be completed by a TVI who has vision-specific knowledge to quantify the levels of service intensity being recommended on the VISSIT tool. And again, for those of you who are wondering what about O&M, we have an O&M VISSIT as well. We're not going to talk about that today, but it is available.
OK, so how often should the VISSIT be completed? When might I complete the VISSIT? Of course, we recommend that a new VISSIT is completed at any time that there is a new functional vision evaluation learning media assessment ECC summary completed, anytime that there's any change in your students-- like, they're coming to your caseload, they're newly diagnosed, 3-year re-evals... changes in vision. Anytime that there might be a need for a new re-evaluation or evaluation and the student need and ECC, we recommend the VISSIT be done again. Ideally, once a year would be great, when everybody's sitting down to determine the next year's IEP for the student.
How do I rate the intensity of student need? Do I have to complete other evaluations to complete the VISSIT? You're going to hear me say this about a million times today. The VISSIT is completed after you get student evaluation results. Please do not use the VISSIT-- do not use the VISSIT as an evaluation tool. That is not what it's designed for, and it is not to be used for that. You get your FVE, LMA, ECC summary results, and then you complete the VISSIT.
When identifying intensity of service need, can I use numbers besides the zero, one, four, seven, 10? No. On the electronic version, you're not able to. The tool will say, you need to put in zero, one, four, seven, 10. If you do it by hand, it will skew the results. So please only use zero, one, four, seven, 10 when doing the scoring for direct or collaborative consultation time.
Should a student who has direct service also have time allotted for educational team support collaboration? Yes. Again, this is probably preaching to the choir, but we really believe that students with visual impairments, especially those with CVI, need both direct and collaborative consultation time.
OK, so this is the exciting part. I'm going to actually walk you through a VISSIT. And we're going to talk a little bit about our sample case study student before I actually walk you through how I would complete this VISSIT with our student. Our student's name is Lilly. For those of you who cannot read the screen, I'm going to go ahead and quickly read this case study.
And I've highlighted, just for those of you can't see, I've highlighted some portions that will be very important when we are filling out the VISSIT. These are going to be the things we're going to be filling out the VISSIT based on. These are part of the evaluation information that we want to base our VISSIT scoring on.
Lilly is a five-year-old girl who has a history of extensive multifocal cystic encephalo-- oh boy, I practiced this and it still didn't come out-- encephalomalacia involving bilateral cerebral hemispheres. So basically, she has some severe brain damage in both hemispheres of her brain.
Doctor X reports that likely cortical visual impairment, legally blind, and appears to have no vision. That is Lilly's diagnosis for visual impairment. Lilly also has a history of HSV meningitis as an infant, cerebral palsy, seizure disorder, encephalopathy, and a developmental delay. She is able to alert to sounds and to her name being called. She will turn or tilt her head toward music, bells, and instruments, music instrument. She can sit in an adapted chair. She will smile when she is happy, and she can demonstrate discomfort, as in when she is wet.
She demonstrates the three distinct criteria for cortical visual impairment. Her eye exam does not explain her functional use of vision, history of neurological incidents, or some neurologic sequelae, and demonstrates the unique visual and behavioral characteristics associated with CVI. OK, so we've probably all known a student a little bit like Lilly.
With regard to her vision and her visual functioning, Lilly is able to visually attend to and track an eight-inch lighted red ball when it's presented in her far left or far right visual field, and no more than 12 inches away from her face. She also visually attends to other targets that are either lighted or have reflective qualities. No distance viewing was observed during the evaluation, other than she stared at the ceiling lights and sunlight out the windows for a brief moment.
Results from her learning media assessment indicate that Lilly relies heavily on her auditory mode for learning, but she will explore real objects that are of a single bright color, reflective, and/or that light up.
Lilly is transitioning from her school-based self-contained classroom into a homebound setting with services that will be provided in her home. The family is concerned about Lilly's ongoing education while she is in homebound placement. They have very few connections friends with VI-related organizations or state agencies.
And the big takeaways, and this is based on her evaluation, Lilly's needs based on her FVE, LMA, ECC report, communication mode and devices are needed. She has none at this point. CVI-related activities for more use of visual sense, so we're looking at sensory efficiency skill training.
And then introduction to more rec leisure activities, because she is five, and she's going to be in a homebound placement, so she won't be around as many students or peers. And those kind of situations in the school day, a lot of times rec leisure activities are built in. So we want to make sure that she's getting skill building in that area once she's in the homebound placement.
OK, so that's our sample-- I mean, our sample student. And I'm going to go ahead and get out of this, and we're going to actually fill out a VISSIT from scratch. So you can open up your own browser, not during this presentation, but once we're done here. You can find the VISSIT at www.tsbvi.edu/vissit.
This is where the VISSIT is housed. It's housed on the Texas School for the Blind website. It's got its very own page. It's got the introduction, the overview, instructions, the form in a Word document, the form in a PDF that's fillable. The two PDFs are the ones that will self-calculate. The Word doc does not self-calculate.
FAQs, I read some of those already in this presentation, but more are available here. The references to the studies that we have published based on the VISSIT for the reliability and validity, if you need to show that to an administrator. Some sample completed forms. Lilly's is included there, too. And then the link to the O&M VISSIT, which is basically the same type of setup, but for the O&M VISSIT.
So I'm going to go ahead and show you guys what this looks like to fill out, this form, based on Lilly. And I'm going to click on the PDF. You can download this to your computer or you can fill it ahead and print it directly from online, OK? This is the cover, and this is what it looks like. And we're going to go ahead, and I'm going to basically talk through this. And if there's any, questions hopefully I'll be able to answer them right at the end. But we're going to go through this fairly quickly.
Don't forget, this is a form that can be included in IEP paperwork, so you want to make sure that-- pardon-- you want to make sure that you fill out all this information clearly. You want to put the student's name, your name, and the date that the visit was actually completed, OK?
I'm going to try to talk through some of my thinking based on Lilly's sample. But if I skip over something be sure to ask about it in the comments section. And I'm going to use these numbers, zero, one four, seven, 10, and I'll show you how I fill this out.
So we're going to start with compensatory skills, literacy, instruction. At this point, we're really not trying to add any of those types of literacy instruction to Lilly's day, so it's going to be a zero and a zero.
Organizational and study skills-- well, Lilly doesn't even have a communication method or mode at this moment. She doesn't have any kind of system, so we can't really ask her to be organized or studied until we get that medium in place. So we're going to put a zero here and a zero there.
Communication modes-- and again, remember that we in our sample, the very first thing that we noticed from the evaluation data was communication mode and device or devices. Those were pretty high-need. But she already does like to manipulate some real objects, and she can respond to her name.
She does have some emotional responses for happy and discomfort. So these are not brand, brand new, but these are definitely skills we want to generalize and develop fluency. So I'm going to go ahead and give that a four for her direct service. And because we are going to be working on these same things with the family, we want them to support those routines and activities to help her generalize and be more fluent with her communication mode. I'm going to put that as a four as well.
OK. So if you'll notice real quick at the bottom, these self-populated. So my page total for each column self-populated. All right. I'm going to go to the next section, and we're going to go to the next ECC skill areas. And we're still in the compensatory skills section.
So access to the core curriculum. Again, she's five. We're really working on more basic concepts at this point, so we're going to give her a zero in core curriculum and a zero for collaborate consultation in a core curriculum.
Concept development, we're going to go ahead and say that, again, she has some very functional basic concept developments, like she understands her name. She knows how to attend to certain auditory cues and signals. But we want to give her more opportunities to do that. We want her to have more time to look at some of those things, and we want to give her a seven here. And because we're going to probably be introducing some new things, we want the parents to have a lot of support from us, so we're going to put a seven there.
OK. Electronic devices-- so we know that one way that we can get Lilly learning is that she really loves things that make sound and that light up. So we're going to start using switches with her, perhaps. We're thinking that might be something that would be enticing for her. And, again, these are things that she already does turn her head to face different auditory devices. She's already manipulating real objects, so we want to use things that-- like, we want to look at skills she already has but maybe needs to generalize and develop fluency. So we're going to put four on the things we're going to work on.
And then over here, the parents don't necessarily have as much that they need to put into this section. This is more going to be us introducing switches and using some of those other devices. That parents can use them, of course, but we want to concentrate more on that concept development part with them and those communication modes with them. We're going to put this as a one, because they need some support, but they're not going to need a ton. And again, these page totals are self-calculating.
OK. Then we get to computer access. Lilly's not at that place right now. We're still just basically getting her used to using objects, and starting to make some of those connections, and expressing her needs, and her emotions, so we're going to put zero and zero. And low-tech devices as well, at this point for the visual impairment piece, we're just going to say zero and zero.
Social interaction skills-- she already has quite a few social interaction skills when it comes to expressing need and expressing happiness. We want to make sure that we continue to bolster that, but those are not the things we want to focus on right this minute. That's not our priority, because again, if we go back to thinking about what the evaluation said we needed to focus on, communication mode and devices, CVI-related activities for a visual sense, so sensory efficiency, and an introduction to more rec leisure activities. Her social interaction skills at this time are not a priority for us or her, so we're going to go ahead and put those at zero.
And again, a lot of the times, we want to make sure that you're using your professional judgment based on the evaluation. And because this is just a quick snapshot, we might want to spend a little more time looking at each one of these areas in depth. But for today's purpose, I just want to show you how we fill it out.
Independent living skills, career ed, and sensory efficiency skills. So again, independent living skills, based on the evaluation, at this point, her caregivers are the ones who are taking care of those skill needs for her. They're feeding her, clothing her, grooming her, toileting her. But we're not going to try to introduce anything new at this point.
The priority in the independent living skills area is really low at this time, so we're going to go ahead and give that a zero and a zero. And, of course, we can be there to consult with the family if they have questions about some better ways to modify or adapt. But at this time, that's not going to be what we're going to focus on as far as our service time.
Career ed, again, those are things even with a student at five years old with multiple impairments, things like choice making and preferences, likes and dislikes, that is part of career ed. But again, those were not priority areas in Lilly's evaluation data, so we're going to go ahead and continue to give that a zero and a zero.
Now, sensory efficiency skills, that was the biggie. We were like, sensory efficiency skills is one of her priority areas from her functional vision evaluation. That's including teaching functional use of vision, hearing, touch, smell, taste. We want to make sure that we give a lot of need to that area.
She does have some use. We know that she's visually attending to certain things-- lighted materials, shiny materials, things that have movement to them. So she already has a few skills, but we know that that's like one of her major needs. So we're going to go ahead and put that as a seven for direct.
And we're going to be doing modeling and working on helping the parents and caregivers to implement some of those same practices, some of those same efficiency skill practices, but it's not going to be as high-need as the direct services right now. We're going to put that as a four. So the family gets some support and gets some training, but we want to take on the bulk of the training as the TVI for direct service.
And we're getting close to the end of this part. Rec leisure, again, that was another area that we said was Introduction to, right? She needs to have some more rec leisure activities introduced. So this is where just understanding how the tool works, it is a low need, but it's still a need area.
So we're going to put it as a one, because we know that we want to give Lilly some opportunities to explore some new rec leisure activities as a five-year-old, but it's not one of the high, high needs. Not a four, seven, 10, but a one. And the same thing with the family needs. We just want to introduce a few things and just make sure that they understand how to implement that with Lilly.
The O&M support from the TVI. OK, so this is different from if an O&M person would do an O&M VISSIT. So we just want to talk about supporting basics skill in O&M, even purposeful movement, that type of thing. That was not noted in her FVE, LMA, ECC evaluation. It was not noted in there, so it does not have a priority need at this time, so we're going to add zero for both of those columns.
OK, and here's the last page. We're talking about the self-determination piece. Again, the high-need areas that were mentioned in our case study from the evaluation, communication mode and devices, CVI-related activities for use of visual sense, so sensory efficiency, an an introduction to more rec leisure activities.
So self-determination was not included there, all right? So we are not going to include it there. Again, all of the areas in the ECC are important, obviously, but we're talking about what the evaluation says at this moment. And so we're going to say zero there and zero here.
So now, we've got the subtotals from the direct and from the educational collaborative team columns. We know that Lilly is transitioning. Back in our case study, it stated that Lilly was going from her self-contained public school classroom back to a homebound setting just because there were some things that needed to be addressed that couldn't be addressed at home, probably medical. That's what homebound placement tends to be. So we're going to give that a plus 10 here, OK?
And you'll notice in the FAQs that for transition, transition can only be plus 10 or zero. Medical status and condition can be plus 10, or minus 10, or zero. We add plus 10 because probably, you're going to have more time needed to make that transition from one placement to another smooth and keep all the VI skills intact.
Also over here in the collaborative support, we're going to give that a plus 10 as well, because the family's going to be taking on quite a bit of the implementation of VI-related skills and ECC-related skills in the home.
She does not have any medical condition that was listed as something that would have affected this current VISSIT, so we're going to put zero and zero in both of those columns.
OK. So now, we have the self-calculated totals in each area. 33 is the total for direct instruction and 27 is the team support collaborative consultation support. Oh, we have to do the additional areas of family support table. I almost forgot that. And this one's is going to be important because a lot of things that were not included in the evaluation are going to be addressed here.
We're going to have 10 for the consistency across school and home. Because now the student is moving to a home setting, there's going to need to be a lot of collaboration that goes on between the TVI and the family. The family also had no connections or few connections with state agencies and support services, so we want to help them get hooked up. So that's a pretty high need.
Facilitating family participation in special education meetings and visits, we noticed in the case study that they do need some information and help with some of those visits and meetings so that they understand what's going on with their child. And then there were no cultural or language differences that were noted. And we wanted to help with some bonding and interaction strategies with their child as well, because they're now going to be having the child 24/7 at home instead of having a respite from that child when they are out of the school.
So we're going to go back to our total. And you'll notice that we have the direct column is 33 and the educational team support is 49. Those numbers represent student need. That's a quantifiable number for a student need. And if you go down to those two forms, the forms populated.
So the direct recommended time, that number was 33. And so that gives me a range of 60 to 90 minutes per week. And I'm going to go ahead and suggest that 60 minutes-- yes.
You have about 10 minutes left.
OK. I am at the very end, which is perfect. I'm going to go ahead and say because this is sort of in the middle, I'm going to just suggest 60 minutes per week for direct time. And because I can get out to Lilly's house, I'm going to say it's going to be 30 minutes two times per week. And that's what I'm going to recommend, and the IEP team seems to be in agreement with that, OK?
And then for collaborative consultation, again, remember that the family's probably going to need a lot more collaboration at the beginning. We're showing 30 to 70 minutes per week. And I'm going to go ahead and put in 45 minutes per week, and I'm going to break that down into roughly-- well, I'm going to go ahead and say 25 minutes two times a week. I'm going to go ahead say 50 minutes, just to make it even. So each time I go out to visit Lilly, I'll spend half an hour with her and I'll spend 25 minutes with her family. And I hope that that makes sense.
So that's what the VISSIT looks like to be filled out. And then, of course, if I needed to, I go back up here to the top, and I can save it, and it'll save to my desktop. OK. And I think-- all right. Now, we're at that time for comments and questions. I'm going to go ahead and put this up so you can see that, and I'm going to--
Wonderful. Thank you so much.
Sure.
Before we go ahead, we do have a couple of questions.
I'm sorry. Do you want me to stop sharing?
No, you can go ahead and leave that up. So the first question is under compensatory skills, it's a question regarding literacy instruction, where you added a zero. And the question is, if the student's literacy modality is objects or pictures, would you not make that a different score if that is their accessible format?
So at this point, again, part of filling out the VISSIT has to do with your professional judgment. It's very interesting, because this was the exact same question that came up when I gave this presentation at the Northeast AER. Everybody else, all the other sections were like, yeah, this is OK. This works. That was the one place that there was some discrepancy between the crowd. We had people answering what they thought should go in there.
Because she doesn't actually have a communication system in place, even though we know at this point, she doesn't seem to be attending to things that would be quote unquote, "in print," she does seem to attend tactually to real objects and certain things that are shiny or lighted. That's what we are assuming she is going to be using as far as a literacy medium, but she has not yet been set up with a true communication system, so we wanted to put that as the priority first.
And once we get that system in place, like a now and finished type of system, calendar system, where we're using real objects with the now and finished box, that would be the priority. And then we could start looking at more concentration on literacy instruction, because we don't even have a method for teaching literacy at this point. So we want to start with the communication mode and then start with literacy instruction once that communication mode is in place.
OK, thank you. Another question is if independent living skills are a team priority, but will be addressed by another direct provider, such as the OT or PT, would it be appropriate to score direct at zero, but the collaboration at one or four?
Absolutely. And again, we want to make sure that the visit is framed on student need only. And you're talking about from the VI perspective. If you know that you're going to be working with an entire team-- like in this case, the student may be in a homebound setting, but it could be in a self-contained classroom setting, and you know you're going to be working with OT, the PT, the speech person, the special ed teacher, the gen ed teachers, whatever, yes, you could add a one or a four in that collaborative consultation section if you see that need come out in the student's evaluation and if you know that that's a priority need for visual impairment services. I hope that made sense.
I don't see a follow-up, so I'm assuming that it answered the question. There is one more question. I'm going to go ahead and read it, although I think this might be one that perhaps they can use your email address for.
But it's specifically about a student who has CVI who has regressed. And the district has decreased services from 18 hours a year to six hours a year. And the question is, how specifically does thae VISSIT help to justify the needs which, in fact, do exist, not just in a model that is concerned with caseload management? So as you're going through the ECC, how are you able to show that those needs are there?
So the idea is that those needs, like those skill gaps and those skill regression pieces, that's going to be shown in your evaluation data and your progress notes. The VISSIT is basically just a quantitative representation of that need.
So if you were to go through and look at some of those skill areas that were there, it's no longer about maintenance, but it's now about moving back up towards mastery of introduced skills, or even acquisition of new skills, which that's going to be indicated by those seven to 10 scores in the direct and the collaborative consultation times. That's how the VISSIT shows increased or higher lead in certain areas. It's by those numbers in the way you score it. But that actual need is going to come from your evaluation data and your progress notes.
OK, great. Thank you. Well, that's all we have for questions, and we're right on time as far as finishing up. So at this point, I'd like to thank you, Dr. Darst, for sharing your knowledge on this important topic. We really appreciate it. It was very interesting.
And also, thank you to the participants for joining us today. And we hope that you found the webinar to be informative, and that you'll join us for future webinars. Our next presentation is April 30 at 3:30, where Marguerite Tibaudo will be presenting on reducing complexity in the environment, and that notification will be going out to everyone on that topic. So thank you very much.
Thank you.