- Considering the magnitude of the need in Caribbean, there is an urgent need to develop active case finding mechanisms. This could be in the form of national surveys, similar to the one previously carried out in Trinidad or through strengthening of primary and secondary eye care networks and promotion of cross-referral.
- These IE programmes are best demonstration models and could be used for the purpose of advocacy. As such in the medium term, there is a need to bring the standards and quality to the desirable level.
- All the children in the programme need to have their comprehensive ophthalmic assessment done before the school enrolment. An early assessment mechanism needs to be developed and implemented.
- Record keeping system needs to be set-up and strengthen. It is important to maintain the assessment record of the children for future interventions.
- A mechanism needs to be developed for early identification, detection, and treatment of children with curable eye conditions and refractive errors. Ideal vehicle for this could be through strengthening of primary eye care and secondary eye services in these countries.
- A focal person has been identified and trained as part of this exercise. This is an addition to a focal person previously trained through the national focal person training programme. There is a need to strengthen the capacity of these national focal persons so they can further identify and organize trainings for ophthalmologists, teachers, and primary health workers.
- There is a need to develop low vision services in Trinidad and Jamaica where children could be provided with appropriate interventions.
- All the itinerant teachers involved with the children with VI needs to be trained as focal point in low vision responsible for the functional assessment and provision of assistive devices. There will also be a requirement of a low vision kit which could be used for this purpose.
- A central inventory of LVDs needs to be developed at CCB HQ with distribution points in individual countries to ensure the access to low vision devices by the children in particular.
- The ophthalmic community, in general, needs to be oriented and sensitised to the needs of children with VI.
- Sensitisation of the teachers regarding cognitive, behavioural and social development of the student needs to be initiated. For this purpose, a dedicated module in LV needs to be initiated at MICO teachers training college and at least one in-services teacher and rehabilitation field officer needs to undergo this training. A resource room needs to be developed at MICO to facilitate this training.
- A comprehensive assessment service (educational performance) needs to be developed to establish the strengths and weaknesses of each student and offer him/her better support.
- The refractionists need to be better trained in refraction and low vision as resource persons. The regional refractionists training programme in Guyana needs to be strengthened to cater this need.
- Different studies suggest that the visual impairment is higher in girls than the boys so positive steps need to be taken to identify and enrol more girl children in the programme.
- Networking with other service providers and additional capacity will be needed to cater to the needs of children with VI and additional disabilities.
Annex A
Clinical and Cognitive Assessment of Children in the
Inclusive Education Programme
TO BE IMPLEMENTED IN 4 COUNTRIES ACROSS THE CARIBBEAN
Terms of Reference
1.0 Rationale
According to surveys carried out over the last ten years in various parts of the world there are a number of children who are either attending special schools or IE programmes who have adequate vision to cope in the mainstream setup. Also there are children who could benefit from surgical or refractive interventions and are needlessly blind. The main reasons for this are lack of coordination between eye care and education services and also the unavailability of personal trained to deal with children who have visual impairment.
Across the Caribbean and around the World; the visually impaired (VI) children can be divided into three sub-categories. Those with moderate visual impairment i.e. between 6/60 to >6/18 can manage well in the mainstream education with some support from teachers’ parents and provision of optical and non-optical low vision (LV) devices. Almost all the children in this category can manage without additional support.
The second group i.e. children with severe visual impairment 3/60 to >6/60 need higher level of intervention and here the prescription and other support required is more complex. The degree of success with mainstream education depends more upon the parents and teachers and varies from case to case. Almost 50% children still can cope in mainstream schools.
Those with vision less than 3/60 (blind) often cannot cope in mainstream education with out support from itinerant teachers however a certain number about 10%-20% can still manage well, especially in higher grades. The remaining children in this category require more intensive support from the itinerant teacher, tactile materials including Braille, assistive technology, and teaching aids.
The Caribbean Council for the Blind and Sightsavers International believe that: All children with visual impairment must be provided with comprehensive clinical examination and those who are LV should be assessed for LV. Spectacles and LV devices (both optical and non-optical in combination with necessary environmental modifications) should be provided to all who can potentially benefit from these. These interventions will have a significant impact on the quality of life and access to education. At least one teacher in each of these schools should be trained and the others sensitised to the special needs of these children.
2.0 Purpose of the review
The purpose of the assessment is to review a random sample of children who are in education programs for children with visual impairment to ascertain their status and initiate steps to introduce more appropriate interventions where required.
The findings will be used to identify those factors or issues, which have influenced the realisation of the programme objectives and to what extent the programme is achieving or likely to achieve its overall aim. The key learning points and recommendations from the review will contribute to the future development of the inclusive education (IE) programme across the Caribbean.
3.0 Objectives
- To conduct a comprehensive clinical assessment of the children (randomly selected) in the programme to ascertain the educational support they require
- To undertake a preliminary cognitive assessment of the children to support development of the programme
- To review the current and planned future coverage of the programme and the implications for this on quality IE services in the country
- To review the achievement of project outcomes against normative expectations among children without visual impairments; and make recommendations as appropriate for the future development of the IE programme.
4.0 Methodology
4.1 The review will involve key stakeholders in the programme. The evaluation team is expected to consist of Refractive Error and Low Vision Advisor to SSI, an ophthalmologist/optometrist with specialisation in LV and one person involved in the programme. The team members will provide the necessary technical knowledge in LV, as well as sound programme management.
4.2 A random sample of 100 children will be drawn from the students in schools providing education services to children who are visually impaired in selected countries across the Caribbean.Children will be randomly selected from schools in the following countries, and examined (by the team) at their schools, or at the national resource unit, which ever is more acceptable, given issues of logistics.
- Jamaica
- Trinidad & Tobago;
- Guyana
- St. Lucia;
A detailed ophthalmic examination and LV assessment will be carried out by the review team. All the children will also undergo a preliminary simple cognitive test that is expected to add value to this assessment exercise and help in future development of the programme. After the examination, children with refractive error (RE) and LV will be advised and provided with appropriate interventions. In addition, the team will also include the necessary skills in analysis and report writing.
4.3 The team will review the project documents, and additional relevant information in advance of the review as well as site information during the review.
5.0 Programme area to be covered
5.1 States: Carribean Countries where CCB is supporting IE programs
5.2 No. of children to be assessed
- 100 in all – sampled as a ratio of the number of children in participating national PROGRAMS. The 4 countries selected will provide suitable ethnic mix.
- Selection will be per IE unit(program), i.e. all children in a selected unit(program) will be assessed, irrespective of the category of visual impairment, including those totally blind
5.3 Assessment centres
The assessment will be done in the following countries:
Guyuna
Jamaica
Trinidad and Tobago
St. Lucia
5.4 Sources of information
Secondary
- Project documents: This is not relevant, since these are not projects but national education program (mostly funded by national Governments. CCB-SSI facilitated establishment of programs by: training teachers, providing some equipment and lobbied for space to establish program.
- Individual case files of children assessed
- Student questionnaire for simple preliminary cognitive assessment. The format along with guidelines for use is given in Annex 4 (this might have to be translated into the local language). (All participating countries speak English as their primary language.
Primary
- Itinerant or class room teachers (in the case of residential programs.
- Project coordinators (Preferably) Principals or head of resource units
- Optometrists/ key paramedical staff associated with the project
- Project directors
- SSI staff
6.0 Team
The core members would be:
- Hasan Minto, SSI RE and LV Advisor
- Petra Vanes, Optometrists – orthorpist – CCB;
* Other personnel to be determined on a country by country basis;
The team will be supported by the partners and local SSI staff, viz:
7.0 Outputs
The evaluation is expected to result in the following key outputs:
- A debriefing with key stakeholders and interested parties
- A programme evaluation report which outlines:
– the key findings of the review
– provides recommendations against the key objectives of the review
– identifies the key learning opportunities for the programme in general and key stakeholders in particular
– Informs of areas for further research.
– 8.0 Timeframe
8.1 In view of the distances and logistic arrangements required to cover the programme, the assessment is expected to require a timeframe of 10 days, which would include 8 days in the field.
9.1 All logistical arrangements will be made by the CCB Regional Offices, with support from partners as appropriate.
9.2 Other logistical details:
9.2.1 The assessment will take place (as far as possible) at the school’s or resource units involved.
9.2.2 Arrangements will be made to ensure that the team travels to the designated locations on a daily basis.
9.2.3 In the case of residential schools, It is anticipated that the children will be examined on a class-by class basis, causing limited disruption in the normal school day.
9.2.4 Children who attend mainstreamed schools, will be deferred from school to participate in the activity, if sampled.
9.2.5 The itinerant or classroom teachers in charge of the selected IE units must accompany the children and be present at the point of assessment.