1. Family-Centered Practices for Young Children with Visual Impairment
Deborah D. Hatton, Ph.D.
July 5, 2007
Toronto, Ontario
Best Start
Ontario Ministry of
Children and Youth
Services
The University of North Carolina at Chapel Hill
Early Intervention Training Center for Infants and Toddlers With Visual Impairments
FPG Child Development Institute Produced in collaboration with R. A. McWilliam and P.J. Winton (2002)

2. Objectives
After completing this session, participants will
1. describe and implement strategies that can be used to build reliable alliances with families and other professionals and to implement family-centered practices.
2. describe and implement strategies to effectively communicate and collaborate with families and other professionals.
3. describe the three types of support that are important for families of young children with visual impairments and explain the advantages of developing an ecomap (a graphic representation of a family’s existing supports).
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

3. Objectives
After completing this session, participants will
identify three key child outcomes and five key family outcomes that should be considered when providing intervention to young children with visual impairments and their families.
complete an ecomap to identify key features of the family ecology that might influence intervention/education.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

4. Objectives
After completing this session, participants will
complete a routines based assessment to identify family concerns, priorities, and resources that describe the strategies that members of teams use to effectively communicate and collaborate with families and other professionals.
identify functional outcomes for intervention that are tied to sensory assessments, ecomaps, and routines based assessment.
describe and implement strategies for successful home visits and consultative visits to child care settings.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

5. Family-Centered Support
reflects a method of coordinating and
delivering assistance, support, and services
to the families of children with disabilities that
enhances their capacity to care for
their children.
is based upon an understanding of the
complexity that exists within families and that
decisions and services will influence each
member of the family and the unit as a whole.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

6. Central Values of Family-Centered Approach
Emphasizing families’ strengths rather than deficits
Promoting family choice and control over desired resources
Developing collaborative relationships between professionals and parents
Viewing family from a holistic perspective
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

7. Establishing Reliable Alliances
The term reliable alliance has been used
by Turnbull and Turnbull (2001) to
describe a dynamic relationship between
families and professionals in which they
experience individual and collective
empowerment by sharing their resources
to make joint decisions.
Turnbull & Turnbull, 2001
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

8. Eight Obligations Involved in Establishing Reliable Alliances
Reliable alliances involve the following eight
obligations (Turnbull & Turnbull, 2001, p. 58):
Knowing yourself
Knowing families
Honoring diversity
Affirming and building on family strengths
Promoting family choices
Affirming appropriate choices
Communicating positively
Warranting trust and respect
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

9. Responses to Grief
Early models of the grieving process included sequential stages of shock, denial, anger, depression, and acceptance.
Today a broader understanding of responses to grief exists. Individuals may sporadically, randomly, or predictably experience sadness, guilt, regret, longing, disbelief, fear, irritability, hopelessness, and powerlessness.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

10. Diversity Diversity refers to differences in individuals and families
across a variety of dimensions, including
culture, language, race, class, disability, age, and gender.
personal affiliations to religious and political groups or beliefs.
sexual orientation.
Family culture can affect
treatment of medical issues.
primary language spoken within the home.
literacy activities.
interactive play (social skills).
daily routines.
Milian & Erin, 2001
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

11. Consider Variations Within Cultures
Families vary in their adherence to cultural
norms based on
primary language in home and community.
educational level.
religious affiliation.
country of origin, length of time in U.S.,
degree of acculturation, or current residence.
income.
Santos & Reese, 1999
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

12. Cultural Diversity and Visual Impairment
Some cultures
believe that caring for the child is more important than teaching independence.
expect adults with blindness/VI to hold only certain jobs or not work at all.
value oral communication over the written word.
vary in their gender expectations.
ascribe special meaning to particular types of visual impairment.
Erin, 2002
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

13. Religious Diversity and Visual Impairment
Some individuals may think that having a visual impairment is retribution for sin.
For some families, a religious leader or
the head of the family may be the critical
decision maker.
Some families visit religious healers during
their child’s early years.
Erin, 2002
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

14. Importance of Collaborating with Families
Almost all child-level intervention occurs between home visit sessions.
Almost all interventions can be implemented in the context of family routines and daily activities.
Infants and toddlers cannot generalize skills that early interventionists model from one visit to the next.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill
R.A. McWilliam August 2004

15. Components of Collaboration
Empowering caregivers to meet children’s needs
Treating caregivers with respect and as full members of the team
Conferring with specialists and other service providers to develop and implement an integrated and comprehensive intervention plan that can be used across settings in daily routines and activities
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

16. Coordinating Services for Young Children with Visual Impairment
Coordinating performance of evaluations and assessments
Facilitating and participating in development, review, and evaluation of intervention plans
Assisting families in identifying available service providers
Coordinating and monitoring delivery of available services
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

17. Coordinating Services for Young Children with Visual Impairment
Informing families of availability of advocacy services
Coordinating with medical and health providers
Facilitating development of a transition plan to other programs, if appropriate
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

18. Four Collaborative Roles for TVIs
Supportive - demonstrating concern and caring for others during new and difficult situations
Facilitative - assisting the professional development of other team members
Informative - providing information and support to other team members
Prescriptive - suggesting strategies or resources in response to a request for assistance
Topor, Holbrook, & Koenig, 2000
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

19. Support-Based Intervention
An overarching feature of early intervention is
the provision of supports, rather than the
provision of services.
McWilliam and Scott (2001) identified three
primary types of support provided by early
interventionists:
Emotional support
Informational support
Material support
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

20. Emotional Support Positiveness Responsiveness
Emotionally supportive, family-centered practitioners have the following characteristics:
Positiveness
Responsiveness
Orientation to the whole family
Friendliness
Sensitivity
Competence with and about children
Competence with and about communities
McWilliam, Tocci, & Harbin, 1998
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

21. Material Support
Families cannot carry out interventions if their needs for food, shelter, and security are not met.
Children with VI may require specialized materials, such as low-vision devices, to enhance participation in daily routines.
Examples of Material Support
Equipment and supplies
Information about resources,
including financial resources
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

22. Informational Support
Families with children with visual impairments
may report concerns about the future and
express a need for information about
child development,
the child’s visual condition,
services and resources, and
specific strategies and skills.
Leyser & Heinze, 2001
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

23. Child and Family Outcomes
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

25. Child Outcomes Overall goal is to enable children to be active
and successful participants in their early
childhood years and in the future.
Three outcomes that reflect achievement of this
goal are:
Children have positive social relationships.
Children acquire and use knowledge and skills.
Children take appropriate action to meet their needs.
ECO Center, 2005
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

26. Family Outcomes
Families understand their children’s strengths, abilities, and special needs.
Families know their rights and advocate effectively.
Families help their children develop and learn.
Families have support systems.
Families access desired services, programs, and activities in their communities.
ECO Center, 2005
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

27. Responsibilities of Professionals who Provide Specialized Services for Young Children with VI
Functional sensory assessments
Adaptations/accommodations to assure accessibility
Functional and meaningful intervention that is tied to assessment results, family priorities, and standards and that can be continuously monitored
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

28. Collaboration Between Professionals and Families
Families provide essential information about the assessment of their children.
Families who are involved in assessment are more likely to understand the process and the results.
Respect for family values, cultures, and priorities is essential in planning and implementing assessments and intervention.
Smith & Levack, 1996
Hatton, McWilliam, & Winton, 2004
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill
PowerPoint 7

29. Family Ecology Family ecology refers to the system of informal
supports available to the family that are
depicted graphically by an ecomap.
An ecomap is used to
identify existing supports, how duplication of efforts might be avoided, and possible gaps that need to be addressed, and
assist in identifying resources that will be required to achieve functional outcomes.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

30. Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

31. Routines-Based Assessment
The RBA is a process whereby families
share their concerns.
identify priorities for early intervention
within the context of everyday activities
and routines, thereby assuring that
early intervention occurs within natural
environments.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

32. Benefits of the RBA The routines-based assessment
emphasizes that intervention is family-centered.
provides a structure for families to have a
meaningful role in planning.
generates a list of functional intervention outcomes.
aids in developing a positive relationship with the family.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

33. Role of the Professional Providing Specialized Services for Children with Visual Impairment
Organize an RBA and conduct the
interview, if this hasn't already been
done
Participate but not be the primary
interviewer
Train other team members to do RBAs
Receive the information after the fact
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

34. Components of Individual Child and Family Service Plans
Statement of current levels of functioning
Statement of the family’s resources, priorities, and concerns
Statement of the long term and short term goals, criteria, procedures, and timelines
Statement of early intervention services, including the frequency, intensity, and method of delivering services
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

35. Components of Individual Child and Family Service Plans
Statement of the natural environments in which services will be provided
Statement of the projected dates for the initiation and duration of services
Identification of the service coordinator
Description of the plan for transition to preschool services
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

36. Key Components of Intervention Plans
Family’s strengths, concerns, and priorities as derived from the RBA
Child’s current level of functioning, as determined by sensory assessments, routines based assessment, and transdisciplinary assessment of child
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

37. Linking Assessment to Outcomes and Services
Services on the intervention plan should be related to needs identified during child and family assessment.
The team should decide on services based upon
outcomes—not upon the diagnosis.
Children may have the same diagnosis, but their
unique strengths and needs may prompt different
outcomes, based on priorities of the family and team.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

38. Developing Intervention Plans Should be a Team Effort
Families are integral members of all teams.
The team agrees upon functional outcomes
and the strategies needed to achieve them.
The team identifies the services and service
providers that can provide the support needed
to achieve the functional outcomes and to
implement strategies.
The team determines the timelines for
achieving the outcomes.
The team identifies the primary home visitor
(and possibly the service coordinator).
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

39. Functional Outcomes For very young children, functionality means
having meaningful social
relationships
acquiring and using knowledge and
skills (engagement),
taking appropriate action to meet their needs (independence)
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

40. Social Relationships Social relationships provide motivation and serve
as the foundation for learning and competence.
Social development involves
forming relationships
(attachment),
communicating,
interacting appropriately,
adapting to new situations,
social interactions (parallel,
associative, cooperative play), and
forming friendships.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

41. Engagement Engagement refers to the child’s developmentally and
contextually appropriate
interactions with the
environment.
To maintain
appropriate engagement, children must continuously acquire and use knowledge and skills.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

42. Independence
Independence refers to children’s ability to function with as little assistance from others as possible and requires children to take appropriate actions to meet their needs.
Independence in
communicating
moving
solving problems
routines
playing
getting along with others
looking after oneself
Independence promotes confidence and self-esteem.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

43. Natural Environments and Children with Visual Impairment
Although provision of services within a child’s natural
environments is the goal, children with visual impairment and their families may also benefit from specialized environments because
children with visual impairment have unique
developmental needs (AER & AFB, 2003).
the presence of visual impairment can prevent an
infant or toddler from accessing the same visual
information available to sighted peers; therefore the
environment may need to be adapted in order to
meet specific needs (Chen, 1999).
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

44. Support for Transitions
Identify the possible future settings
Identify the skills of all people involved in the
transition
Provide the primary interventionist in the new
setting with information about the child
Key personnel who worked with the child
before the transition should maintain contact
with the new professionals
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

45. Major Goal of Home Visits
Provide support that promotes functional outcomes for family and child. Support can be
informational,
material, or
emotional.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

46. Recommended Practice for Home Visits
Collaborate with families and with other specialists and service providers.
Use routines-based intervention to achieve functional outcomes.
Assure that a team approach with close collaboration is used to support families and children.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

47. Role of Specialists in VI
Primary Home Visitor
Responsible for regular weekly home visits
Responsible for securing information from specialists and incorporating into integrated strategies for functional outcomes
Responsible for intervention plan development, implementation, monitoring
Responsible for transition planning
Consultant
Identifies priorities from primary home visitor while formulating recommendations related
to visual impairment
Makes joint visits with primary home visitor
Provides technical assistance to primary
home visitor and direct service to child and family through joint home visits
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill

48. Additional Resources For hundreds of resources on family-centered
practices for young children with visual
impairment, go to
or see Resources section of the website for the
Early Intervention Training Center for Infants
and Toddlers with Visual Impairments at
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute University of North Carolina at Chapel Hill