Flinders University, School of Education
One educational option that has got more and more attention is meeting the needs of students with disabilities in regular classes instead of put the students in segregated classrooms. Children with blind and visual impairment tend to have a variety of problems whether related to education, social, emotional, health, use of leisure time and work. All these problems should be anticipated to provide education, guidance, counseling, training so that the problems that arise can be anticipated as early as possible. Although inclusion has already become an essential part of the education for students with visual impairment by providing appropriate services, this approach might not accommodate their needs yet. This paper will explain the term “low vision”. It then will describe the potential barriers and/or challenges that could hinder the pace of development of services for students with low vision. Finally, this paper will answer the question of “How does the services for a student with visual impairment (low vision) accommodate their needs in an inclusive classroom setting?”. In the last section, this paper will also give recommendations to improving the educational services for this students.
Inclusion system has been applied in Indonesia over the last decade ago. Although there are a lot of definitions of inclusion, Its aim is to put all students, including students with special needs, together in the regular classroom full time where services are provided (WEAC.org 2015; cited in Anastasiou, Kauffman, & Di Nuovo, 2015). This system requires schools to accommodate the needs of students with disabilities and provide appropriate services. These aims are also stated in the Indonesia’s regulation which states that learners who have a physical, emotional, mental, social disorder, and/or has a potential of intelligence and/or special talents, need to get educational services appropriate to their needs and rights (Permendiknas, 2015).
Blind and visual impairment are one of the disabilities that need an attention due to its large number of the population. Visual impairment or low vision can be defined as "a person who has impairment of visual functioning even after treatment and/or refractive correction, and has a visual acuity of less than 6/18 to light perception, or a visual field of less than 10° from the point of fixation, but who uses, or is potentially able to use, vision for the planning and/or execution of a task" (Rakhi, 2006, para. 11). According to this definition, there are four aspects used to described low vision condition. First, after being treated and corrected with glasses, still have abnormalities in the function of vision. Second, having a 6/18 visual acuity (20/60) until the perception of light.Third, the field of vision is less than 10 degrees. Last, people with this condition still can use or potential use of residual vision in planning and carry out daily activities.
The number of people with low vision is unpredictable. World Health Organization (2014) states that the number of people with low vision is a tripling of the number of totally blind, and almost 90% of these people are living in the developing countries. Similar to this, according to Global Estimates of Visual Impairment (Pascolini & Mariotti, 2010; cited in Chiang, Marella, Ormsby, & Keeffe, 2012), around two-third of people with visual impairment from a total number of the world population is living in Asia-Pacific region. In fact, in Indonesia, there are approximately 2 million people with a blind condition but there are no accurate data on the number of people with visual impairment. Consequently, students with low vision were might not meet the appropriate educational services they need because they are not identified and cannot be recognized easily.
Educational services for students with visual impairment are slightly different from non-disabled students or students with a totally blind condition. McDonough, Sticken, and Haack (2006) state that students with low vision have difficulties in terms of reading or gain information through visual materials. In fact, they need other ways of obtaining information, such as using optical devices or modified the materials by making a large print text. These services will enable them to read or gain information, build relationships or conversing without visual feedback from other persons' expressions and gestures, and getting around safely and efficiently (McDonough et al., 2006). Additionally, besides academic, low vision condition also have an impact on the quality of life, independence, and social relationships (Stelmack, Rosenbloom, Brenneman, Stelmack, 2003; cited in Chiang et al., 2012). Thus, basically, the service for student with low vision addresses not only to vision aspect but also the consequences to other aspect such as social, psychological, emotional, functional, and economic (Lamoureux, Pallant, Pesudovs, Rees, Hassell, & Keeffe, 2007; cited in Chiang et al., 2012).
However, globally, the availability of services for low vision in most countries is only about less than 10% (Chiang, O'Connor, Le Mesurier, & Keeffe, 2011; cited in Chiang et al., 2012). In addition, in 1995, although U.S. Department of Education has issued a policy guidance, the public schools has recognized that the current services for some visually impaired students, were not fulfilled the students’ needs yet (Heumann & Hehir, 1995; cited in McDonough et al., 2006). In Indonesia, for example, this happens because of a lack of community understanding of low vision, including among ophthalmologists. Indeed, most of the ophthalmologists (82.3%) identified lack of training to providing low vision services (Khan, Shamanna, & Nuthethi, 2005).
The barriers to access the services that faced by children and young people with visual impairment came not only from the lack of understanding but also come from many factors. According to research by Chiang et al. (2012), they were found that lack of funding, distance to the nearest service - which means that the services were too far to reach, lack of awareness of services that are available, deficient in or no referral networks, inadequate communication between clients and health workers, and having a hopeless perception has become barriers to access the low vision services. Other barriers were occurred from internal factors such as lack of awareness of low vision services and lack of understanding of the term “low vision” among people with low vision themselves (Pollard, Simpson, Lamoureux, & Keeffe, 2003). Consequently, they did not realize that they having a low vision. Pollard et al. (2003) also found that the image of the service only focused on the publicity of blind people, which makes this services difficult for people with low vision to relate to. In addition, people from low socioeconomic society, living in rural areas, females, children, ethnic minorities, refugees, aged people (Chiang et al., 2012) also tended to have a difficult access to the services. Moreover, lots of research had been conducted to determine the appropriate services for students with low vision, even though it was not easy. Layton and Lock (2001) was admitted that it was difficult to examine the cause of learning difficulties in low vision student because its complexity of distinguishing between external factors {such as the use of assistive technology) and internal factors (such as lack of reading comprehensive).
In terms of assistive technology, which play an important role in supporting students with disabilities (in this case, low vision student), Indonesia facing funding problem to provide the services for these students (Andersen et al., 2003). Research by May‐Teerink (1995; Borg, Lindström, & Larsson, 2011) found that particularly in developing countries, lack of funding has become the major barriers to access assistive technology. In addition, teachers of students with visual impairment did not have the knowledge and skills to teach the technology to their students. Whereas, low vision students should have a connection to teachers who have sufficient knowledge and skills of assistive technology to get benefit from it (Abner & Lahm, 2002).
Besides the obstacles, these students will also face another challenge. One major challenge is the optical devices used by low vision student to improve their reading speed and comprehension. Although there was a modified such as make a larger print text, it seems that using optical devices were not made any improvement in terms of speed and comprehension reading. Research has found that there were no significant differences between reading using a variety large print text and reading with standard (10-point or 12 points font) using an optical device (Sykes, 1971; Morris, 1973; Sloan & Habel 1973; cited in Andersen et al., 2003). Need to be noted that even though the students who are visually impaired can use their low vision reading aids appropriately and is receiving specialized adaptation in terms of instructions, accommodations, and modifications, they will still struggle with learning difficulties (Layton & Lock, 2001).
Furthermore, these barriers have also occurred among teachers who teach low vision students in the regular classrooms. Lieberman, Houston-Wilson, and Kozub (2002) found that there were four barriers faced by the teachers. First, the teachers were felt that they lack knowledge and skills required to deal with these students. They may need training and experiences trough professional a preparation program in order to develop the curriculum. Second, the lack of appropriate equipment to support the teachers to delivered their educational goals. It is necessary to use the suitable equipment such as audiobook, bright balls, tactile guidewires, and others. Third, lack of adequate programming often appeared in the inclusive classrooms. The teachers were not considered about the limitation of a student who has visually impaired in terms of implementing the curriculum. For example, in sport, team sport such as football, volleyball or basketball will not appropriate for a student with low vision. Although they might get benefited from modification or adjustments, the implementation might not be easy because low vision has different characteristics compare to blind students. Thus, individual sports such as athletic or swimming might more appropriate for these students. Last, time in a schedule is the barrier that always mentioned by teachers. Teachers need additional or extra time to taught low vision student individually. This means that teachers should spend their time (outside the regular learning time) to give more or re-explain the materials given on that day.
Despite the barriers mentioned above, lot of different models of low vision services have been developed and implemented in order to improve functional ability and quality of life of people with visual impairment, where each model was reported to have a positive result (Binns et al, 2012. cited in Lim, Vukicevic, Koklanis, & Boyle, 2014). As Lim et al. (2014) state, there are three models of low vision services. Firstly, the Primary Model (community-based), which involving community health centers and community-based services providers. This model provides basic services such as vision screening, functional vision assessment, referral to low vision services, and prescription or recommendation for low vision devices. Community-based rehabilitation approach is a model that is practical, feasible, and commonly used in developing countries, where government organizations and NGOs bring their services to the community, especially for rural and remote communities. Secondly, Mid-level model (clinical), involves the eye care professional such as an ophthalmologist, orthoptists, and psychologists /counselors. Patients received standard hospital-based services such as diagnosis and treatment in accordance with the conditions of their eyes, ratings, recipes, and training in the use of low vision devices. This model is different from the primary model, where patients have to travel to the eye hospital or specialized agencies to obtain the services. The costs for providing these services is quite large so that only a small number of people able to access the services of this model. Thirdly, a Tertiary model is an integration between multidisciplinary services. This model provides a holistic eye care services, including occupational therapy and orientation and mobility instruction. In addition, vocational training (education as well as daily living skills) is also offered to gain self-reliance to cope with integration into mainstream society. This model of low vision service is widely applied in developed countries.
In spite of what model is being applied, school teachers and health workers need to working together to provide a comprehensive, systematic, well-planned, and professional services to help students who have visually impaired to overcome their obstacles and challenges so they can perform well in their learning process. In fact, among developing countries such as Indonesia where inclusion is developing, the awareness of the needs if low vision services are increasing (Silver, Gilbert, Spoerer, & Foster, 1995). Thus, services for low vision student is provide based on variety approach. As A. L. Corn and Erin (2010) stated the organized use of a team approach and is required to provide effective low vision services. Research by Andersen et al. (2003), which explored about the Providing Access to the Visual Environment (Project PAVE), was using a team approach (multidisciplinary model) to provide services for low vision students. According to this project, there are five basic philosophy of education services for low vision, namely: the provision of optical devices, assistance and training in the use of optical devices, the psychological effects of the use of optical devices, proprietary optical devices, and optical devices as a tool for self-reliance (Andersen et al., 2003).
To planning effective low vision services, assessment to determining students who have vision handicapped is important. In India, the use of population-based assessment was very useful to determining people with visual impairment and use it to develop the services (Dandona et al., 2002). Based on the team approach, services in India has provided by eye health care workers, specialized advisors such as orientation and mobility instructor and school teachers. The eye-care workers will assess and provide both optical and non-optical low vision devices. The instructor will help to overcome the mobility difficulties and school teachers will help to overcome academic problems. In addition, the services also include modifications in instruction such as direct and consultative instructional services (A. Corn & Koenig, 2002), accommodation (Lueck et al., 2003), and the core curriculum for visually impaired (McDonough et al., 2006).
In conclusion, this paper indicates that there are barriers to access low vision services, from both external and internal factors, which are perceived by low vision students in developing countries, particularly Indonesia. Therefore, an effort should be made to make provision of low vision services an essential part of comprehensive, systematic, well-planned, and professional eye-care services for the student with visual impairment. This paper recommends the government of Indonesia to promote the awareness and understanding about low vision services addressed for the community, the eye-care providers, and school personnel. Furthermore, the availability of low vision services for students depends on the availability of human resources trained in providing these services. Therefore, the government should provide training for teachers and health eye-care workers based on the need for these services to rise up the number of trained personnel. Lastly, the government should find a way to make low vision devices available and affordable for students with low vision by reducing the cost of optical and assistive technology devices.
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