Facilitating Participation in Education: The Distinctive Role of the Specialist Teacher in Supporting Learners with Vision Impairment in Combination with Severe and Profound and Multiple Learning Difficulties

By Mike McLinden, Graeme Douglas, Rachel Hewett, Rory Cobb, and Paul Lynch

Mike McLinden is Professor in Education at the University of Birmingham, Birmingham, United Kingdom.

Graeme Douglas is Professor of Disability and Special Educational Needs at the University of Birmingham, United Kingdom.

Rachel Hewett is a Birmingham Fellow at the University of Birmingham, United Kingdom.

Rory Cobb is Chair of VIEW (Professional Association of the Visual Impairment Workforce), United Kingdom.

Paul Lynch is a Senior Lecturer in Inclusive Education at the University of Birmingham, United Kingdom.

Abstract

Within the wide range of needs created by vision impairment in combination with severe and profound and multiple learning difficulties (SLD/PMLD) the potential influence of impaired vision on a learner's participation in education can be neglected. This paper examines the distinctive role of specialist teachers of children with vision impairment in facilitating such participation through reference to the children and youth version of the International Classification of Functioning, Disability and Health (ICF-CY) and a bioecological systems theory. A bioecological model is outlined that incorporates the language and approach to disability in the ICF-CY with the systems theory to enable a holistic analysis of the role. An important aspect of the role is considered to be the facilitation of a learner's participation in education through the promotion of progressive and mutual accommodation over a given timeframe. The implications of the model for future research are examined with reference to a person-process-context-time (PPCT) design.

Keywords

Vision impairment, learning difficulties, ICF-CY, bioecological systems theory

Introduction

Children and young people with vision impairment in combination with other difficulties constitute a heterogeneous group. Practitioners and researchers are only beginning to appreciate the complexities, and subtleties, of vision in their development with an increased appreciation that learners who do not receive consistent information through this modality are more reliant on significant others to mediate their learning experiences (McLinden, 2012; McLinden & McCall, 2010). Support for these children and young people is provided by a wide range of practitioners, including input from specialist teachers of children and young people with vision impairments. In an analysis of the role of these specialist teachers in affording curriculum access, McLinden, Douglas, Cobb, Hewett, and Ravenscroft (2016) outline a dual model of access as a means of illustrating the teacher's role in: (1) ensuring that the child's environment is structured to promote learning throughout their education (i.e., access to learning), and (2) supporting the child to learn distinctive skills in order to afford more independent learning (i.e., learning to access). The notion of developing and promoting independence across a given developmental timeframe is considered to lie at the heart of the distinction between each strand of this dual view of access, with the approaches not considered to be mutually exclusive and with each required at different stages in the child's educational career depending on the particular curriculum context. Bronfenbrenner's bioecological systems theory (Bronfenbrenner, 1979, 2005) is drawn upon as a lens through which to conceptualise and navigate the issues the teachers negotiate in facilitating an appropriate curriculum balance to allow children to acquire key curriculum skills. This theory emphasises the interrelatedness between the developing person and the context in which development takes place with a particular focus on the ways in which "reciprocal interactions between these systems influence development" (Derksen, 2010, p. 336).

 

McLinden et al. (2016) conclude their analysis of the specialist teacher's role by arguing that as well as supporting curriculum access, a central concern of practitioners and researchers should be to identify and remove barriers to access in all forms to enable learners with vision impairments to participate effectively in education and society. In this article we build on this conclusion to examine the broader role of the specialist teacher of learners with vision impairment in facilitating participation in education through identifying and removing such barriers. Given that the implications of vision impairment can be neglected when considering the multiplication of needs in learners with significant additional disabilities (McLinden & McCall, 2010), our particular focus is concerned with analysing this role in relation to learners with vision impairment in combination with severe learning difficulties (SLD) or profound and multiple learning difficulties (PMLD). We begin by examining the needs of these learners with a focus on the educational context in the United Kingdom (UK). This overview serves to highlight the heterogeneity of needs and the wide range of factors that may influence the development of these children and young people. To provide a holistic language and framework for examining these factors from a biological, individual, and social perspective we first make reference to the children and youth version of the International Classification of Functioning, Disability and Health(ICF-CY) (World Health Organization [WHO], 2007). This classification offers a vocabulary and approach to disability that can be drawn upon to navigate the complex relationships between the individual child, significant deviation or loss in vision and/or other body parts, the child's execution of tasks or actions (activity) and participation in a given life situation. It is noted in the ICF-CY that as changes in the environments of children and young people are associated with their increasing competence and independence, these environments can be viewed as a series of successive systems that surround them with each differing in its influence as a function of the age or stage of the developing child (WHO, 2007, p. xvi).

We conceptualise these successive systems through reference to Bronfenbrenner's bioecological systems theory (Bronfenbrenner, 2005) and outline a new conceptual model which integrates the ICF-CY and Bronfenbrenner's theory. This bioecological model is drawn upon to illustrate the proximal (i.e. relatively close to the learner) and distal (i.e. relatively distant from the learner) influences on the participation of learners with SLD/PMLD, with reference made to an illustrative child profile. An important aspect of the specialist teacher's role is shown to be facilitating accommodations that are designed to be both progressive and mutual, through seeking to reduce potential barriers to access within a learner's different learning environments whilst developing and promoting his or her independence skills. In the final section we explore the implications of drawing on a bioecological systems theory for future research with reference to a person-process-context-time (PPCT) design. We conclude by outlining how the conceptual model outlined in this paper provides a more holistic overview of the role of the specialist teacher in facilitating participation for learners with SLD/PMLD. We emphasise its significance in providing an approach and research design that can be drawn upon to examine the distinctive role of the specialist teacher and through which to compare this role with other practitioners who support learners with significant needs in a complex educational ecology.

Learners with Vision Impairment in Combination with SLD/PMLD

Vision impairment is a broad term that refers to a range of difficulties from minor impairment in visual function through to little or no vision (McLinden & Douglas, 2013), with a broad distinction often made between ocular and cerebral vision impairment (CVI) (Hodges & McLinden, 2014; McLinden & Douglas, 2013). As noted by Corn and Erin (2010), CVI is a common cause of visual loss in people who have more complex needs, involving damage to the brain or the pathways to the brain resulting in difficulties in interpreting the visual environment. Estimates of the total number of children and young people with visual impairment in combination with other disabilities vary significantly. These variations are partly the result of different definitions and terminology being drawn upon for the purpose of describing their needs. The complexity of accurately describing these needs is noted by McLinden and McCall (2002) in reporting that they include a wide range of sensory, intellectual and/or physical impairments, as well as medical conditions which can occur in different combinations. As an example, approximately 20% of children and young people with visual impairment in the UK are described as having additional special educational needs and/or disabilities (SEND) with a further 30% reported as having complex needs (Keil, 2014).

The spectrum of complex needs includes learners who have learning difficulties that are described as being severe or profound and multiple (i.e. SLD/PMLD) (Keil, 2014). Whilst there is no single definition of these learning difficulties, a succinct summary is described in the SEND Code of Practice in England as:

Severe learning difficulties (SLD), where children are likely to need support in all areas of the curriculum and associated difficulties with mobility and communication, through to profound and multiple learning difficulties (PMLD), where children are likely to have severe and complex learning difficulties as well as a physical disability or sensory impairment. (Department for Education, 2015, p. 86).

In relation to attainment within the curriculum these children and young people will be functioning within early developmental levels throughout their education pathway (McLinden & McCall, 2002). Although relatively few may be diagnosed as being blind, it can be difficult to measure with any certainty the degree of their functional or useful vision. Further, as noted by McLinden and McCall (2010), in addition to ocular or cerebral vision impairment, many of these learners will also have impaired vision function as a result of physical or motor difficulties which restrict their ability to use parts of their body to gather visual information in a timely manner.

McLinden and Douglas (2013) note that within the spectrum of need created by vision impairment, a key barrier faced by children is reduced access to information in order to develop their knowledge, understanding, and skills. The impact of reduced access through the sense of vision has significant implications for development and participation particularly in combination with other disabilities (McLinden & McCall, 2002). As such it is argued that a significant feature of learners with vision impairment and significant additional needs is an increased dependency on other individuals to structure their learning experiences, including consideration of their interactions with people and objects, as well as different types of sensory experiences (McLinden & McCall, 2010).

Educational support will be provided by a range of practitioners, and in many national contexts will include input from a specialist teacher of children with vision impairment, often working in an advisory role to provide services to the classroom teacher and other team members at the school, as well as to provide direct services to the learner with a vision impairment (Silberman & Sacks, 2007). The work of these specialist teachers is varied but in the context of education, McLinden et al. (2016) argue that an important aspect of the role is to find appropriate ways of reducing potential barriers to access through the deployment of appropriate strategies which includes a complex blend of ensuring the learner is able to access the curriculum (although not necessarily requiring direct input from themselves) and equipping the child with the necessary competencies and confidence to be able to independently access the curriculum area. Of significance, however, is that multiplication of needs arising from vision impairment in combination with SLD/PMLD, serves to limit fully independent learning within education thereby ensuring greater reliance on adult partners throughout a child's educational pathway (McLinden & McCall, 2002).

We examine next those factors that can influence the participation of learners with vision impairment and SLD/PMLD in education through reference to the children and youth version of the international classification of functioning and disability (ICF-CY) (WHO, 2007). This framework provides a holistic language and approach for examining such factors from different perspectives and helps to understand the complex relationshipsbetween the child, significant deviation or loss in visual function and other body parts, execution of particular tasks or actions, and participation in a given life situation.

Examining Environmental Factors that Influence Participation in Education through the ICF-CY

The ICF is conceptualised around a biopsychosocial approach to disability in attempting to achieve "a synthesis, in order to provide a coherent view of different perspectives of health from a biological, individual and social perspective" (WHO, 2002, p. 19). The overall aim of the ICF classification is described as being to provide "a unified and standard language and framework for the description of health and health-related states" (WHO, 2002, p. 3). The domains contained in the ICF are presented as health and health-related domains and are described from the perspective of the body, the individual, and society in two basic lists: (1) Body Functions and Structures; and (2) Activities and Participation. The ICF also lists environmental factors that may interact with these constructs thereby enabling profiles to be made of an individual's functioning, disability, and health in various domains. As a classification system, it is reported that the ICF is not intended to model the process of functioning and disability, but can be used to describe this by offering a means to map the different constructs thereby providing "a multi-perspective approach to the classification of functioning and disability as an interactive and evolutionary process" and "the building blocks for users who wish to create models and study different aspects of this process" (WHO, 2002, p. 17).

The ICF-CY is derived from the ICF and was designed to record the characteristics of a developing child and the influence of his or her environment given that the "manifestations of disability and health conditions in children and adolescents are different in nature, intensity and impact from those of adults" (WHO, 2002, p. vii). The interactions between the various components in the model of disability that form the basis for the ICF-CY are illustrated in the schematic representation presented below in Figure 1.

Figure 1. Schematic representation of the interactions between the components in the model of disability drawn upon within the ICF and ICF-CY (adapted from WHO, 2002, 2007).

The figure illustrates how an individual’s participation in activities is influenced by a complex relationship between Body Functions and Structure, Contextual Factors in the form of environmental and personal factors and Health Condition as described through disorder or disease.

Examples of these constructs are presented in Table 1 with examples provided with respect to children with vision impairment and SLD/PMLD.

Table 1. ICF-CY components of Body Functions and Structures and Activity and Participation with examples presented with respect to children with vision impairment and SLD/PMLD (adapted from WHO, 2007).

Domain

Definition

Description

Examples with respect to children with vision impairment and SLD/PMLD

Body Functions and Structures

Body functions are the physiological functions of body systems (including psychological functions).

Body structures refer to anatomical parts of the body such as organs, limbs and their components.

Impairments in body function or structure are considered as a significant deviation or loss.

Seeing and related functions (e.g., ocular vision impairment resulting in loss of visual function)

Movement functions

Eye and related structures (e.g., structure of the eyeball)

Movement (e.g., upper and lower extremities)

Activities and Participation

Activity refers to the execution of a task or action by an individual.

Participation refers to involvement in a life situation.

Activity limitations are difficulties an individual may have in executing activities.

Participation restrictions are problems an individual may have in involvement in life situations.

Limitations in independent mobility (e.g., vision impairment in combination with movement limitations).

Participation restrictions with physical activities (e.g., class, playground and social).

The relationship between the components summarised in Figure 1 serves to illustrate that a child's functioning in a specific domain is conceptualised within the ICF-CY as being an interaction or a complex relationship (WHO, 2002, p. 17) between the health condition and contextual factors (i.e. environmental and personal factors). Indeed, it is noted that there is considered to be "a dynamic interaction among these entities: interventions in one entity have the potential to modify one or more of the other entities" (WHO, 2002, p. 17).

The ICF-CY is not considered to be a diagnosis for a child, but rather to provide a profile of his or her functioning for the purpose of describing "the nature and severity of the limitations of the child's functioning and identify the environmental factors influencing such functioning" (WHO, 2007, p. xix). The classification and coding of dimensions of disability in the ICF-CY is described as requiring consideration of limitations of body functions, body structures, activities, and participation in physical, social, and psychological development (WHO, 2007) with guidance structured around five questions that are designed to assign codes to problems manifested by children with disabilities:

  1. Is the child or adolescent manifesting problems in bodily functions?
  2. Does the child or adolescent have problems of organ, limb or other body structures?
  3. Does the child or adolescent have problems executing tasks or actions (i.e., activities)?
  4. Does the child or adolescent have problems engaging in age appropriate life situations (i.e., participation)?
  5. Are there environmental factors that restrict or facilitate the child's or adolescent's functioning?

The detailed nature of the classification system used to establish a child profile is outside the scope of this article, but in summary is based on an alphanumeric coding system: "b" for Body Function, "s" for Body Structures, "d" for Activities/Participation and "e" for Environmental Factors. Each letter is followed by a numeric code that starts with the chapter number (one digit), followed by the second level heading (two digits), and the third and fourth level headings (one digit each). A universal qualifier with values from 0 (no problem) to 4 (complete problem) is entered after the decimal point to specify the extent to which a function or activity differs from an expected or typical state. Environmental factors are considered to make up the physical, social, and attitudinal environment in which people live and conduct their lives. These factors are described as being "extrinsic to the individual (e.g., the attitudes of the society, architectural characteristics, the legal system)" (WHO, 2007, p.18), and are coded through reference to a positive or negative scale to indicate the extent to which a particular factor acts as a barrier or facilitator. Personal factors are described broadly as including "gender, race, age, fitness, lifestyle, habits, coping styles and other such factors" (WHO, 2007, p.18). While such factors are considered to influence how disability is experienced by the individual, and as such are recognised in the interactive model, they are not specifically coded in the ICF or the ICF-CY with their assessment described as being "left to the user, if needed" (WHO, 2007, p. 18).  

The developmental perspective within the framework is based on participation within the restricted environments of the infant and young child that reflect their limited mobility and the need to assure their safety and security, through to participation in environments of their everyday life that are described as being closely connected to the child's home and school and that gradually become "more diversified into environments in the larger context of community and society" (WHO, 2007, p. xvi). It is argued that these environments can be described in terms of a series of successive systems surrounding the child with each differing in its influence depending on the age or stage of the developing child (WHO, 2007). The precise nature of these systems is not identified in the ICF-CY, however, but rather described in generic terms. To identify the respective influence of different factors within a given system on participation in education, we consider next Bronfenbrenner's bioecological systems theory of development (Bronfenbrenner, 2005) through which to examine the complex interactions between the child with vision impairment and SLD/PMLD and the changing environments within which development takes place.

Examining Influences on Development through a Bioecological Systems Theory

Bronfenbrenner (2005) presented the cornerstone of the theoretical structure underpinning the ecology of human development as being "the scientific study of the progressive, mutual accommodation, throughout the life course" (p. 107, original italics) between an active growing individual and the changing properties of the immediate environments in which the individual lives given that this process is affected by the relations between these environments, and by the larger contexts in which the environments are situated. Although originally developed as an ecological systems theory, the model was refined over a period of some years by Bronfenbrenner, with reference made to bioecological as a way of acknowledging the significant role of the active individual in development (Bronfenbrenner, 2005). Reference is still made to both terms in the literature but for the purpose of this article we draw on the most recent terminology.

As noted by McLinden et al. (2016), extensive reference is made to the bioecological theory in child development literature in considering the multilayered influences on human development. The context within human development that takes place is commonly represented as a series of concentric circles situated around a developing individual (Anderson, Boyle, & Deppeler, 2014; Rogoff, 2003) with each circle referring to nested but separate systems to reflect the complex ecology in which humans develop. Surrounding the individual at the centre of the ecology is the microsystem which incorporates "the complex of relations between the developing person and the environment in an immediate setting containing the person" (Bronfenbrenner, 1977, p. 515). The next surrounding system is conceptualized as the mesosystem which comprises "the interrelations amongst major settings containing the developing person at a particular point in his or her life" (Bronfenbrenner, 1977, p. 515), and incorporates "the linkages and processes taking place between two or more settings containing the developing person" (Bronfenbrenner, 2005, p. 148). Situated around the mesosystem is the exosystem which encompasses "the linkage and processes taking place between two or more settings, at least one of which does not ordinarily contain the developing person, but in which events occur that influence processes within the immediate setting that does contain that person" (Bronfenbrenner, 2005, p. 148). The outer system within this ecology, referred to as the macrosystem, consists "of the overarching pattern of micro-, meso-, and exosystems characteristic of a given culture, subculture, or other broader social context" that is described as "a societal blueprint for a particular culture, subculture, or other broader social context" (Bronfenbrenner, 2005, p. 149-150). Finally, the chronosystem incorporates the time element of human development.

Although influential in accounting for a range of influences on development, of note is that Bronfenbrenner's bioecological systems theory was not conceptualised as a framework for classifying disability per se, nor to account specifically for influences that concern the development of learners with disabilities. There is evidence, however, to indicate the value of drawing on the theory in order to analyse educational practice with respect to children with developmental disabilities (Beveridge, 2005; Bricout, Porterfield, Tracey, & Howard, 2004; Kamenopoulou, 2016). As an example, Beveridge (2005) claims that it is helpful in highlighting that the activities undertaken with a child will include other types of settings and relationships that may be particular to that child or group of children (e.g., regular attendance at a health clinic). Further, in discussing different of models of disability (i.e., medical, social, and transactional) for children with developmental disabilities, Bricout et al. (2004) argue that neither the medical nor social models gives proper consideration of the meso-level activities in relation to children with disabilities. The importance of this level is reported as being "where children with disabilities and their families interact with institutions such as schools and social service agencies, transpersonal factors, such as interpersonal, family and organizational dynamics" (p. 52) that serve as influences on the child's quality of life. They propose that in order to consider these interactions simultaneously an ecological model is required that integrates "the medical model, focused on individual deficits, the social model, focused on disabling social environments, and the transactional model, focused on person-environment interactions" (Bricout et al. 2004, p. 45). Through incorporating the language and approach from the biopsychosocial approach to disability in the ICF-CY with Bronfenbrenner's bioecological systems theory of development, a conceptual model is outlined in Figure 2 that seeks to provide such integration with respect to learners with vision impairment and SLD/PMLD.

Figure 2. A bioecological model integrating the ICF-CY and bioecological systems theory to examine multi-layered influences on the participation in education of learners with vision impairment and SLD/PMLD (adapted from Bronfenbrenner, 2005; McLinden et al. 2016; WHO, 2007).

This figure illustrates how the ICF-CY can be integrated with a bioecological systems theory. The learner is located at the centre of the model and is described with respect to impairment in body functions and structures and personal factors. In relation to the learning environments within different settings in the microsystem, the components Activities and Participation describe potential limitations in a learner’s activities and restrictions in participation. The environmental factors that can act as barriers or facilitators to a learner’s participation in education within and between the micro-, meso-, exo- and macro-systems are illustrated in the model as arrows that interconnect the respective systems.

We consider next how this conceptual model can offer a holistic framework through which to analyse multi-layered influences on the development of learners with vision impairment and SLD/PMLD with a particular focus on the distinctive role of the specialist teacher of children with vision impairment in facilitating their participation in education. The analysis is illustrated through reference to an illustrative child profile of a young learner with vision impairment in combination with additional needs to indicate aspects of the role of a specialist teacher in facilitating her participation in education (Figure 3). 

Figure 3. Illustrative child profile of a learner with vision impairment and profound and multiple learning difficulties.

Danny
  • Danny is four years old. She was born with profound and multiple learning difficulties that include, an ocular condition (congenital cataracts), a cardiovascular condition and significant coordination difficulties that impact on her fine and gross motor development.
  • Danny attends a local nursery for young children with special educational needs with support provided by a range of professionals including a full time teaching assistant. The nursery is an old building and wheelchair access is limited.
  • Danny's vision impairment in combination with mobility and communication difficulties has a significant impact on her ability to access the curriculum in the nursery. It is not clear how well she is able to see given inconsistent responses to visual assessment in a clinical setting. Input is provided on a weekly basis by a visiting specialist teacher of children and young people with vision impairments.
  • Danny has no independent mobility as yet and spends the majority of her waking hours in a wheelchair or standing frame with a head rest to ensure her head and upper body stay upright. She has regular physiotherapy and is very motivated by sessions in the swimming pool of a local school which she attends once a week with her teaching assistant as part of her physiotheraphy timetable. Given that the changing rooms are located on a different level to the foyer, Danny is not able to enter them in her wheelchair and needs to be carried into the changing area.
  • Danny has limited speech and communicates her basic needs through gestures and eye pointing. She is learning to use object symbols in combination with switch technology to indicate simple choices with input from a communication therapist.

Analysing the Role of the Specialist Teacher in Facilitating Participation

A potential strength of a bioecological systems model is that it includes a focus on the characteristics of the individual learner, as well as acknowledging the complexity and multi-dimensional nature of the influences on development over a given timeframe. In relation to the learner at the centre of the conceptual model outlined in Figure 2, the components Body Structures and Functions describe the anatomical parts of the body that may be affected (e.g., eye/visual system), the physiological functions of body systems, and the extent of any deviation or loss in these (e.g., loss in visual function). With reference to the illustrative child profile, Danny has been diagnosed with an ocular condition affecting her vision (congenital cataracts), a cardiovascular condition, and significant coordination difficulties that impact on her fine and gross motor development.

In considering the extent to which the child manifests problems in body functions and/or structures (WHO, 2007), reference to the ICF-CY provides a means of the specialist teacher using an internationally recognized coding system to indicate the extent to which structure is affected and the functional loss arising from this. As such it offers a helpful tool for making comparisons in body functions and structures across disciplinary and educational contexts.  The specialist teacher will have knowledge of particular structures and functions concerning the eye and related visual processing pathways to ensure that the implications of a given vision impairment (whether ocular or cerebral) are given due consideration in identifying the learner's needs. With reference to the illustrative child profile, Danny can be classified as having severe or complete impairment in a number of categories within body functions. This includes: seeing and related function (b210); functions of the cardiovascular system (b410), and movement functions (b760), as well as severe impairment in a number of body structures including the nervous system (structure of the brain); the eye and related structures (structure of the eyeball), structure of cardiovascular system (heart), and movement (upper and lower extremities).

In relation to the child's learning environments within different settings in the microsystem, the components Activities and Participation describe potential limitations in activities and restrictions in participation. Determining the extent to which a child has problems in executing tasks or actions (activities) and can engage in age-appropriate life situations (participation) within a given learning environment will be helpful in assessing the implications for learning and participation arising from any functional loss, whilst taking into account the multiplication of need arising from impairments in other categories of body functions and structures. With reference to the illustrative child profile, Danny is classified as having severe or complete activity limitations and participation restrictions in a number of domains, including learning and applying knowledge, communication, mobility, and major life areas. Given her physical restrictions, she is not able to participate in all curriculum areas and often has to miss some classes to attend physiotherapy sessions.

The role of the specialist teacher is varied and includes a variety of skills needed to apply knowledge gained from assessment of the implications of vision impairment to promote activities and participation (Mason & McCall, 2001; McLinden & McCracken, 2016). With reference to the illustrative child profile, the specialist teacher is engaged in establishing connections with the child and her family in various settings through making weekly home visits, supporting visits to educational settings and assessment clinics, and clarifying the role of the various supporting agencies. Although a comprehensive clinical assessment of her visual function has not been possible to date, a functional vision assessment is to be undertaken by the specialist teacher working in collaboration with family and staff in the home and nursery settings.

The notion of progressive, mutual accommodation within Bronfenbrenner's bioecological theory (Bronfenbrenner, 2005) is of particular relevance in the specialist teacher's role as it highlights a need not to focus just on the learner or the environment in isolation, but rather the changing relationships between these over time and in different settings (McLinden et al. 2016). A key aspect of the role, therefore, is to facilitate accommodations that are designed to be both progressive and mutual–namely, through seeking to reduce potential barriers to access within the child's different learning environments over a given timeframe, whilst developing and promoting the child's independence skills. The changing nature of the learning environments over time is represented in the bioecological model through the chronosystem which equates with broad phases of education in a given national context (e.g., early years, primary, secondary, and further/higher). Transition is acknowledged in the ICF-CY as being a central issue in that the nature and complexity of children's environments change when transitioning between the different stages of development (WHO, 2007). The support provided by a specialist teacher to ensure a smooth transition from one phase to another offers an example of how the holistic analysis presented in the bioecological model can help to conceptualise the distinctive nature of this role to facilitate participation. Promoting effective transition through understanding the principles and practices associated with successful transition is an important aspect of the specialist teacher's role (Mason & McCall, 1997) and in relation to a bioecological systems model resonates with Bronfenbrenner's notion of bioecological transitions (Bronfenbrenner, 2005) as learners move from one setting to another (Hewett, Douglas, McLinden, & Keil, 2017).

The environmental factors that have relevance to a transition programme are described in the ICF-CY within the broad heading Education which includes preschool education and school education. As reported by McLinden and McCracken (2016), the work of the specialist teacher will include activities in facilitating successful transition that can be conceptualised within the microsystem (e.g., undertaking an assessment of a child's needs); the mesosystem (e.g., preparing staff in the new school for supporting a child with vision impairment; undertaking an environmental audit to identify factors that serve as potential barriers to participation); as well as the exosystem (e.g., liaising with the school about budget allocations; ensuring policy documents are suitably inclusive of children with vision impairment), to ensure these factors act as facilitators rather than barriers to a child's future participation in a new setting. To ensure the accommodation is considered to be progressive and mutual in preparing a respective educational setting to receive a child, the child will also need support in developing various skills to participate in the setting. In relation to the illustrative child profile, this includes working with the family and other practitioners to develop the child's wheelchair mobility skills to increase her independence within a new setting, providing her with opportunities to use symbols to indicate choices, and supporting her to use technology for communication with others. 

Environmental factors as conceptualised in the ICF-CY (WHO, 2007) are in themselves essentially neutral descriptors. To a greater or lesser extent, however, they can act as barriers or facilitators to participation in education within and between systems and as such are illustrated in this model as arrows that interconnect the respective systems. The environmental factors that restrict or facilitate the child's functioning in the various learning environments are broadly divided into physical, attitudinal, and social in the ICF-CY. The environmental factors are organized in the ICF-CY classification to focus on two different levels:

  • Individual – in the immediate environment of the individual, including settings such as home, workplace, and school. Included at this level are the physical and material features of the environment that an individual comes face to face with, as well as direct contact with others such as family, acquaintances, peers, and strangers.
  • Societal – formal and informal social structures, services and overarching approaches or systems in the community or society that have an impact on individuals.

As such the specialist teacher will be working within and between systems in order to identify and reduce potential barriers to access. In relation to the illustrative child profile, an example of a physical factor in the immediate environment that can act as a significant barrier for Danny is restricted access for wheelchair users to the changing room in the swimming pool of the adjoining school. In facilitating participation the teacher will seek to reduce this barrier at the individual level through undertaking an environmental audit and working with staff in the school building to ensure that appropriate access can be provided (e.g., through use of a wheelchair ramp and high contrast symbols). At a societal level (captured in the outer systems of the bioecological model) the specialist teacher will be aware of, and be able to make reference to, the particular requirements governing access to public buildings (including schools). Whilst there may not be opportunities to directly influence activities within the outer systems, the specialist teacher will need to be familiar with the national legislative and educational framework relating to learners with special educational needs and disabilities in a particular national context and be able to advise accordingly. Finally, attitudinal factors within the ICF-CY range from individual attitudes of immediate family members to societal norms more generally. As such the specialist teacher will be seeking to identify and reduce potential barriers within different systems, including working with the family and health professionals, as well as influencing written policies and documents. This includes, for example, influencing individual attitudes of particular professionals towards the selection of assessment tools to ensure they are sensitive to the needs of the particular child.

Implications for Research – Process-Person-Time-Context Model

Approximately two decades ago, Lewis and Collis (1997) reported that that the issue of vision impairment in combination with multiple handicaps was "probably the most significant challenge for practice, theory and for empirical research as we approach the 21st century" (p. 135), claiming that it is:

Significant for practice because of the numbers of children involved relative to the numbers of with blindness but not other significant impairments. It is significant for theory because it is not clear what kind of models might be appropriate. It is significant for empirical work because of the diversity among the children involved, and because of the uncertainty as to precisely what functional systems are damaged – the more 'multiple' the damage, the harder it is to identify the components of damaged (p. 135-136).

Despite these challenges, Lewis and Collis (1997) mapped out an optimistic view of developmental theory that conceptualised "theory driving research into the problem of multiple handicap" (p.136). The conceptual model outlined in this paper offers the potential for a shift in how theory can drive future research in line with such a call.

A research design that is explicitly situated in Bronfenbrenner's bioecological systems theory is referred to by Tudge, Mokrova, Hatfield, and Karnik (2009) as Process-Person-Context-Time (PPCT), given that the theory in its developed form deals with the interrelations among each of these four elements. Tudge et al. (2009) argue that in order to undertake a study that is guided by Bronfenbrenner's bioecological systems theory, all four elements of the PPCT model should be present, or in specifying the design, those elements not drawn upon should be clearly acknowledged to ensure the integrity of the theory is preserved. Incorporating the terminology and approach of the ICF-CY within a PPCT design therefore suggests some innovative possibilities for future research in order to examine the developmental influences on children with vision impairment and SLD/PMLD and the selected practitioner roles in facilitating participation. Such a design would have as a primary focus not the active learner or the learning context per se, but rather the progressive and mutual accommodation between the learner and his or her successive learning environments, with consideration of those factors that act as potential barriers or facilitators to such accommodation. This would entail ensuring the design includes reference to each element in the PPCT design (i.e., Process–progressively more complex reciprocal interactions between the child and the environment;  Person–personal characteristics of the learner, nature of individual needs arising from a particular blend of disabilities; Context–the particular system under examination; and Time–evaluating interactions through a longitudinal dimension). An example of such a focus would be an examination of the nature of the pedagogical supports provided by a given practitioner role to facilitate learning in a particular educational setting (e.g., early years to primary phase) and how these combine with the interactions among selected characteristics of a sample of learners (e.g., age, degree of vision, nature of disabilities, etc.) to influence aspects of select developmental outcomes (e.g., academic and broader achievements, employability outcomes, progression to further study, etc.) over a given timeframe.

Conclusion and Implications

We have argued in this paper that a bioecological model integrating the ICF-CY approach to disability with a broad bioecological systems theory of development allows for a more holistic overview of the distinctive role of the specialist teacher of children with vision impairment in supporting learners with vision impairment and SLD/PMLD across educational settings and contexts. Reference to the bioecological systems theory is considered to promote "a dynamic, person-context relational view of the process of human development," acknowledging "the individual's contribution to the process of development is made by a synthesis, an integration, between the active person and his or her active context" (Lerner, 2005, p. xviii). Further work is planned to examine the particular nature of the reciprocal interactions within this process for learners with vision impairment and SLD/PMLD in order to gain insights into the proximal and distal influences on development so as to most effectively facilitate their participation in education. This includes drawing on the conceptual model outlined in this paper to provide an approach and related research design to examine the distinctive role of the specialist teacher of children with vision impairment and compare their role with other practitioners who support these children so as to optimise individual development within a complex educational ecology.

Implications for Practitioners and Families

Within the wide range of needs created by vision impairment in combination with severe and profound and multiple learning difficulties (SLD/PMLD) the potential influence of impaired vision on a learner's participation in education can be neglected. Drawing on the language and approach to disability outlined in the ICF-CY, and incorporating these with the principles underpinning the bioecological systems theory, helps to inform practitioners and families about the distinctive role of specialist teachers of learners with visual impairment. This is of particular relevance given the wide range of practitioners who may be involved in supporting learners who have visual impairment in combination with other significant learning difficulties.

A potential strength of a bioecological systems model is that it includes a focus on the characteristics of the individual learner, as well as acknowledging the complexity and multi-dimensional nature of the influences on development over a given timeframe. Reference to the new bioecological model proposed in this paper therefore offers a means to examine the multi-layered influences on a learner's participation in education and helps to inform what the specialist teacher does (i.e., in showing how teachers seek to facilitate participation through identifying and reducing potential barriers to access over a given timeframe); who they support in this role (i.e., learners in a range of educational settings with particular needs that include vision impairment); where the role is undertaken (i.e., in showing how the teachers work within and between the successive systems surrounding the learner); when the input is provided (i.e., in relation to the educational phases outlined in the chronosystem); and how the specialist teachers undertake this role (i.e., in emphasising the importance of facilitating participation through promoting progressive and mutual accommodation between the learner and the learning environment).

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