A DIFFERENT FAMILY - HAVING A VISUALLY IMPAIRED CHILD AND THE DEVELOPMENTS IN A FAMILY By: Mrs Eliane Bonamie (Belgium)

Orthopedagogue, co-ordinator of the home guidance centre for visually im paired children Co-author: Leen van Belle Social worker at the home guidance centre for visually impaired children Dear audience, My lecture is based on experience and examples in the work of early care ium. Some of the families are Turkish. I hope that the ideas can offer inspiration working in the Turkish society. Each parent, no matter what culture he comes from, will nce and go through the process of having a handicapped child in his own individual have to respect this.

in Belg to you, experie way. We

I hope that during this congress I can get some feedback. Thank you for that. "You can't learn anything to someone, you can only help him to discover it insi de himself". Galile . ABSTRACT. After 20 years of practical experience in early home guidance for visually impai red children, we would like to draw your attention to the family. After all, the child is imme rsed in the family system, and the child and parent-oriented work is continuously influencin g each other. During daily guidance, both parents and child are involved so that we can speak about mutual enrichment. From a social and psychological way of thinking, we are formulating some ideas in which we are situating our way of working with the families of visually impa ired children. Basic principles are: social, perspectives, deviation from the rule, shared terr itory, truth and interpretations of the truth, everything is communication. We want to describe a nd illustrate a start of using these concepts. 1. INTRODUCTION We can look at the early home guidance for the visually impaired children from d ifferent points of view. We can consider the guidance of the evolution of visually impair ed children, but that is not what it is all about. We can also consider the guidance of the f amily with a visually impaired child. That is what we want to do. We want to describe the bas ic attitude from which the different workers (.) of our service act. This attitude may look

familiar, to home workers in families with children with a disability of a different kind. (.) The workers of our service have various academic degrees: pediatrist, ortopedagogue, social worker, special educator, therapist. In the article below, we will call them: 'HOME WORKERS'. 2. EARLY HOME GUIDANCE: A SHORT HISTORY The foundation of the early home guidance centres in Flanders was based on three motives: 1. The needs of the visually impaired children; 2. The needs of the parents and the whole family; 3. The social context: the integration of the impaired child in its natural envi ronment. The first years in the process of growth of a young visually impaired child are of the utmost importance. The child is in full development and, as a result, its ability to co rrect and compensate functional deficiencies is at its best. The parents of a young visual ly impaired child will find themselves in a crisis and will have to cope with a number of di fficult tasks. They will have to deal with the disability of their child emotionally and they w ill have to learn how to handle their child. In addition, they have to get over the attitude and t he reactions of the environment. They have to adapt themselves to the influence a visually impai red child has on the functioning of their family, on their marriage and on the social function ing of each parent separately. The first home guidance centres in Flanders started in the seventies as experime ntal projects. In 1988, the centres were officially recognised by law. 3. PEDAGOGICAL FAMILY-ORIENTED MODEL The concept of family guidance is designed for each child separately, and is the result of the needs and demands of both parents and visually impaired child, linked to what we , as home workers, can offer as help. We get our theoretical options from: 1. Orthopedagogy and developmental psychology; 2. The social and psychological sciences; 3. Paramedical and medical insights, in other words, ideas concerning education, development, family and society are a complementary source of inspiration. The abovementioned is the basis from which we let our daily activities grow in t he model for family guidance. We would like to illustrate some aspects of our journey. 4. CHARACTERISTICS OF THE FAMILIES

YOUNG families with a YOUNG visually impaired child. 1. The centripetal lifecycle The lifecycle refers to the phases of development of the family. Dependent on th e developmental tasks in the family in a certain period, we speak of alternate cen tripetal (internally directed) movements. Young families, extending themselves, use a lot of internally directed energy: - In order to take care of and educate young children. The visually impaired ch ild needs more attention; - Self-evident romance disappears in the relationship with the partner. The visu ally impaired child sharpens the existing family patterns. The white spots in the par ent's relationship or the delicate balance between family and work can be considered problematic again. The relationship between the parents is under high pressure a nd, as a consequence of the crisis, the family strengthens the centripetal forces which m ay cause complete isolation. 2. Every family has its own life structure A life structure refers to the organisation of a family: habits, rituals, the ru les of the game, the notions, role patterns, history. We recognise the single- parent family, the gra ndparents living at home, the jumble family, the loose-sand family, the multiproblem family; the importance of the extended family, of the members of the village. the culture of "We" in which the feeling of being a member of a group is important. Each family tries to find its own way of integrating the visually impaired child into its organisation. The indiv idual differences vary greatly. 3. They become another kind of family by the arrival of a visually impaired chil d The family is burdened with the feeling that it no longer meets the standards as to education, parenthood, being a good family A different child can create a family of a different kind. Given the setting of a disability in a wider social context, the awareness of being the parents of a visually impaired child has farreaching consequences. The parents are aware of the fact that their educational task, which is already difficult, may become even more difficult. The existing and self-evident educational values lose their obviousness. The family begins its search for a new identity. 4. The visually impaired child brings some areas of tension Because of the visually impaired child, the family can end up in a long unexpect ed crisis, in the course of which all kinds of states of mind alternate: fear, uncertainly, de nial, doubt, rebellion, losing heart, having enough of it. There may also be moments of a new perspective, of satisfaction and delight, of quietness and delight, of quietness and a sense

of well-being. This harmony can all of a sudden turn into disappointment and rebellion. They are all experiences that belong to life. The process of accepting is a roa d that never ends, and on which one constantly evaluates. It often looks as if you are walkin g on a road where you find a lot of inconsistencies through which you trie to find reconcili ation. Let's have a closer look at some contrasts - Parents have to give their child the opportunity of expressing its feelings. B ut at the same time, the parents are living through their own distress and disappointment. It i s not easy at all to go into a full consideration of someone else's distress when you are very sad yourself. (Care for the child's emotions care for the parents' own emotions) - Parents have to take care of their child, but as this child turns out to be a problem child, parents have a lot of questions about its future. It is not easy to take care of someone while you are burdened down with worries. (Care for the child parents' own worries) - Only if the relationship between the parents is a very good one, they will be able to endure their troubles together. Living together with a visually impaired child may rend er the relationship between the parents more difficult. The understanding between both partners can become stronger but may also diminish. (a good relationship stress caused by the disability). - The family finds itself faced with the task of leading a life as normal as pos sible. The restrictions caused by the visual disability may result in the constant complica tion of a lot of aspects of a normal lifestyle. (the wish to lead a normal life disability causes restrictions) - The parents try to deal with the consequences of the visual disability in an a dequate manner. In some cases, this may require of one or both parents that they introdu ce changes (mostly restrictions) in their professional situation. On the other hand, the di sability can involve extra expenses. (restrictions in the professional situation extra expenses) - Parents are constantly faced with the problem of reconciling the extra attenti on asked by their impaired child and the attention and care needed by their other children. (attention for the impaired child attention for the other children) Helping, guiding and supporting these families is not an easy task. Moreover, ho me workers als have to live through and cope with their own emotions while empathising with the child

and its family. 5. Co-operation with families in early home guidance never starts with a clean s tart Some experiences in previous contacts with (medical) experts may have had an imp roving effect. Other experiences may have inflicted deep wounds, such as the first anno uncement of the disability, the advice in connection with referral, the reactions of the env ironment. We often hear the same story: an abrupt, over-simplified, far from hopeful announce ment, no attention for the emotional life, constant uncertainty, contradictory advice, a lack of set terms, an exaggerated display of professionalism. Parents are asking for clear and hone st information with hope and time to accept. 5. BASIC PHILOSOPHY In the social intercourse with people, we recognise the duality between: 1. Respect for the individuality of each person; 2. Respect and attention for the social reality of every individual. The environ ment of every human being consists of a number of social contacts, values and standards. If we now put our mind to the subject in relation to early home care, we discove r two important issues. 1. Support of self-esteem, the creativity and the individuality of parents, chil d, grandparents, brothers and sisters, bearing in mind that their physical and emotional resource s are not unlimited;

2. The constant attention for the family, the environment, the social values and standards. 6. HOW DO WE LOOK AT THE FAMILIES? Some aspects. 1. Values and standards in society and the art of being different Or: to have an eye for the broad context in which the disability is situated an d to learn how to live in a lifelong situation of being different. 1.1 Social Perspectives Few people realise to what extend their own behaviour is influenced by the expec tations of religion and people around them. That 'one' has certain ideas about how 'one' has to behave or think in a particular environment. These rules are seldom written down , but still they can be very determining for our daily life. These thoughts, these mir rors are called 'social perspectives' and can become an important form of social control. They are effective in the various fields of life, such as parenthood, partnership, being

the wife or husband or child of someone, being a neighbour, an employee. So, one and the sam e person is subject to several social perspectives. 1.2 Social Perspectives in the field of education We now focus on the social perspectives in the field of education. In our practice, we notice an often recurring phenomenon: when something goes wr ong with a child, its parents very often feel guilty or ashamed. In a society where expectations concerning social roles (= being a member of the society) and concerning honour (= getting honour is a priority) are very high, the fact of having a child with pro blems can be a reason for feeling ashamed, or for being burdened down with the question of wh o is to blame. After all, everyone wants to have a perfect child, and there is not much room for error. Society and religion set out standards that contain contradictions. Some examples: - Children are treasures on earth and are very important for parents to become a full member of the family; - Children are active, vital, adorable, and will become a good member of the gro up; - You should not cuddle them too much, nor should you treat them in a cool way; - You have to keep a close track of a child's evolution, but at the same time yo u have to give it the opportunity to develop its self-reliance; - You have to stimulate children, but you need to be careful not to overwhelm th em with too high an expectation; - A son will succeed his father as head of the family. 1.3 Social Perspectives in the field of special education But what happens when your child is blind, partially sighted or multi-handicappe d? The outside world is always present in the inner world of the educational environmen t. Whether or not the family is aware of it, grandparents, relatives, friends, neig hbours, teachers to put it shortly, society is watching! (What if they knew what would the y think if.) Parents of a visually impaired child feel that their family differs from the sta ndard family. These differences display themselves in a lot of daily activities, such as: - A different organisation of the household. For instance: it may be very difficult to find a baby-sitter for a blind toddler . The parents have to agree on their evening activities among themselves or on excludi ng some social commitments. - An attitude problem in social life.

For instance: family and friends do not know how to behave while visiting the ne w mother and her visually impaired baby. - Expectations in regard to the development of the child need to be adapted. e.g. Specific stimulation concerning the motor development of the blind child; e.g. Affection should be given according to the mental age of a multihandicapped child instead of its calendar age; e.g. Going to an ordinary school is not so obvious and requires specific guidanc e; e.g. An overwhelming tolerance towards the handicapped child can lead to an atti tude of understimulation; e.g. The primary goal of education differs, to give the child a comfortable life becomes a priority; e.g. Shall the child be able to marry. Those hundreds of moments a day will make a family feel different. This can hea vily burden the members of the family. 1.4. Aspects of Care. ? during the process of early home guidance, it is important to support the pare nts in their communication and to focus on the exchange of information between family and soc iety. Aspects: - Being aware of what society expects; - Recognise and express one's own sensitivities concerning this subject; - To be able and willing to take notice of the fact that they are different; - Use the skills to handle all this so that the disadvantages one experiences be come less; - Give information to ignorant third persons. ? For that purpose we offer them a safe place to experiment where they talk can about 'being different'. The home worker comes into the family as an element of social reality, but the home worker has competence and is a professional in the education of vis ually impaired children. The early home guidance may be a place where disappointments can be discussed and successes can be celebrated. It may also provide the opportunity t o have contact with people who find themselves in the same situation. This step towards the external world is not so obvious. On the one hand, the par ents tend to withdraw from society because it is the source of all repression, disapproval and criticism on their being different. On the other hand, they need society to crea te a new identity and to receive appreciation. Home workers are also subject to social rules describing how good and adequate t hey ought to be.

for instance: - God is powerful and what he gives is good; - You have to keep on believing that the situation will improve; - You are an adequate home worker when you solve problems quickly; - You solve a problem by talking about it; - You are always available; - Solutions and recovery will be found in the medical world; - The will of God is critical. These expectations influence the relationship with the families in a permanent a nd mutual way. As a home worker, you belong to their separate world of 'being different'. 2. The shared territory.

2.1 Territory. The essence of territory is possession: we call a country, objects, privileges, rights a territory. The possessive urge is territorial. A person's territory consists of those spheres of action in which he or she has a special ability, takes initiatives and bears the responsibility, in other words a field over which he/she exercises supervision. Territorial behaviour plays an important part in the organisation of the lives and the behav iour of people and in the development of a group identity. 2.2 Education as a co-territory. The education of a visually impaired child becomes a shared area between parents and home workers. It becomes a co-territory. For instance: to make contact with and handle the visually impaired child, to stimulate its development, requires a specific b ehaviour It is important for the parents to experience that they remain responsible for t heir child in this territory and that we recognise their engagement. The parents consult the h ome workers as experts who can support them in their own professional ability. (They do not have a real choice nor a free one.) It becomes shared care within a common objec tive: 'let their child and their family function as good as possible as a full member of so ciety'. We should also take into account that the home workers enter into an important p hysical space of the parents who ask for help: we are visiting their homes. Indeed, the home worker spends a minimum of one hour a week in the house of a family which asks f or help. 2.3 Aspects of care. A shared territory demands a negotiation about the tasks and the limits resultin g in a satisfactory compromise for both parties. The negotiation contains, to name a few:

the recognition of the shared territory and its place within the communi cation; the temporary sharing of the management of the territorial rights and th e respect of everyone's capabilities. For instance: The parents accept active concerning guidance focused on the development of the child, but they can refuse to talk about the relations in their family. This is a process i n the course of which one commits oneself more and more and the essence of parenthood is being q uestioned. This requires an open relationship based on mutual trust, intensive moments of c ommunicativeness, respect for each others integrity and limits. Both parties have to look after their own interests but at the same time they ha ve to maintain an atmosphere of confidence. It may be useful to lay down the first agreements c oncerning the mutual expectation (how and under which conditions are parents and centre willin g to cooperate). Sharing a territory may not always take place very smoothly. Some parents consid er education to be their exclusive right, others abandon everything. Home workers m ay ignore the limits of the family. A simple pedagogic advice with the best intentions oft en contains the implicit expectation that the parents are going to apply the advice unconditio nally. This may lead to a breaking point. The process remains an important assignment: for the p arent to admit us, as well as for the home worker to enter into the territory. Without any doub t, it is very important that we remain aware of the importance of the different territories, a nd remain so in every stage of communication in early care. 3. The truth.

3.1 Truth. We can start from the basic assumption that a human being is always busy with hi s own interpretations, definitions, determinations of the meaning of everyday events. We attach a meaning to facts under the influence of all kinds of circumstances in our envi ronment. This environment is characterised by values and standards and by an elaborate ne twork of personal and social connections and relationships. Starting from this environmen t, every human being creates his/her 'own truth', his/her own interpretation of the facts (various worlds of meaning). Searching for THE truth becomes unnecessary. 3.2 Aspects of care The early home guidance does not solve problems, but tries to get people to deal with their problems in a different way.

They cannot take the disability away from the child but they can support the fam ily (and the child). We try to learn them how to cope with 'being different'. In other w ords, the worker guide helps to build up a vision from which the family can go on living, often survive. For example: Women and men have different ways of reacting to the fact that they have a visua lly impaired child. A woman might blame her husband that he cannot handle talking about the v isually impaired child, while he might reproach her that she has no time left for their relationship. Home guidance can contribute to solving this problem: the home worker can explai n to the woman in question that it is not uncommon that her husband reacts in this way; t hat many others act in the same way (= to make the information recognisable). He can expl ain that, while acting like this, her husband tries to deal with the fact of having a visu ally impaired child and that this behaviour will allow him to handle the situation and to make choices for the child on a more rational basis (= to interpret the behaviour of her husband in another way). It is obvious, there are not any rules for how to accept the fact of havin g a visually impaired child. It is important to be aware of the fact that the home guidance centre has its ow n truths and reasons as well, starting from typical, mostly change-oriented patterns. 3.3 Truth and communication. The attribution of a meaning to the facts is reflected in the communication with the family. The communication studies teach us that everything is communication. Any thing we do or do not do in regard to the family will be interpreted by them one way o r another. Let's be aware of the power (to define in another way will give courage) and the traps (differences in interpretations can create misunderstandings) of communication. So, the early home guidance is a search for a kind of communication with the fam ily and the visually impaired child, in addition to which: - the centre tries to provide a vision from which the family can live; the family gets energy to go on growing, to adapt itself to a new situat ion while maintaining its integrity; the family is able to take on the developmental tasks, also concerning t he visually impaired child; - the self-esteem of each individual is supported; - the family can restore order in its duties; - the guidance of a child's development is part of the communication with the fa mily.

7. CONCLUSION The home worker who wants to give home guidance to a family with a visually impa ired child., in a professional manner, has to stand side by side with them as a compa nion, as a supporting element in their difficult task of learning how to live a life of bei ng different. Early home guidance demands a flexible and creative attitude of the home worker. It pr esupposes a constant integration into the organisation of the reality of the family with a v iew on social rules, values and standards. It also presupposes a fundamental respect for peopl e with all their possibilities and restrictions. Or, to quote a colleague of mine: "In this fascinating, sometimes confusing and demanding reality of family life, the home care worker should be a gentle, encouraging tolerant voice. The voice of a listening and symphatising person; someone who can take control and lead the way, supported by his own expertise and skills, and who can do this time after time, over and over again." We repeat that our search for ideas is liable to adjustment, it is not supposed to be a closed framework. "If you want to change the river's bed, don't stand in the middle of it. It does n't work that way. Rather stands at the river's bank and follow the movement of the water and lead it into its new channel. that's the line to take." ERICKSON. "You can't learn anything to someone you can only help him to discover it inside himself." GALILEI. Early Home Care presents a place to doubt and healing. These statements seem very relevant for the home worker who gives support to a f amily with a young visually impaired child.

MULTI-HANDICAPPED VISUALLY IMPAIRED CHILDREN By: Mr Eberhard Fuchs (Germany)

Distinguished participants, I am honoured and pleased to be invited to speak about the field of multidisabil ity at this important and outstandingly organized conference. As we all know, the limitation of time does not allow us to go very deeply into the educational

problem of multidisability. Please, understand that my remarks will only scratch the surface in a more or less technical way. A second point to take into account is the fact th at I am in no way familiar with the cultured background of families with handicapped children, with special services by the government, schools, etc., in Turkey. The situation I am talking about is the situation in Bavaria, Germany, in my institution, the Blindeninstitutsstiftung i n W rzburg. So, I beg your pardon from the very beginning on not being able to generalise. Speaking about multidisabled, visually impaired children means to speak about mo re than 70% of the blind children at schoolgoing age, at least in my country. Less and l ess visually impaired children attend special schools for the blind, more and more multidisab led visually impaired children replace the number of visually impaired children with normal i ntelligence in these special schools. The number of multidisabled visually impaired children is still increasing. So the teachers in the schools for blind people are facing other cha llenges than those they had been trained for. Some remarks concerning the history of teaching multidisabled, visually impaired children. Maybe you have and had similar experiences to ours. When I started working as a teacher (25 years ago) in the foundation for the blind in W rzburg, Germany (Bavaria), this tr aditional school already existed for as long as 125 years. It has been a tiny little schoo l, 6 teachers, some educators. In 1972, the Blindeninstitutsstiftung was asked by the Bavarian government to provide services for multidisabled, visually impaired pupils. At that time, t he authorities felt that in the future, 40 children at schoolgoing age in Bavaria would need su ch a special facility. Twenty five years later, my institution is taking care of about 1,500 multidisabled, visually impaired persons of different age groups: - Early Intervention (around 500 children): 0 - 8 years old; - School, preschool (around 600 children): 6 - 21 years old; - Sheltered workshops (around 300 adults). The centre in W rzburg became too small, satellite institutions had to be founded in several other cities in Bavaria, schools in Munich, N rnberg and Regensburg, combined with Early Intervention centres and, in addition, two more Early Intervention centres in Ku lmbach and Aschaffenburg. So on the whole: - 4 schools, 6 Early Intervention centres; - 2 sheltered workshops. A short excursion to some interesting numbers of schools and pupils attending th em (the numbers represent the year 1995):

Which are the handicapping conditions of multidisabled, visually impaired person s (the results are based on the children in our institutions): 100% visually impaired 85% mentally retarded 70% physically handicapped 45% suffer from epilepsy 5% hearing deficiencies 56% of our children is profoundly, very seriously handicapped. At this point, we need to think about: Who is identified as multidisabled, visually impaired? The E.B.U. accepted the following common description (developed by the commissio n for multidisabled, visually impaired people): - there are at least two serious disabilities; - neither of these disabilities plays a dominant role; - the usual compensations and specific methods cannot be put into practice; - the multidisabled condition cannot by approached by solving separate problems of separate handicaps; - a new approach has to be developed because multidisability is not characterise d by one of the disabilities, but by the fact that the combination of these disabilities cre ated something new. Multidisability has its own identity. Multidisability does not refer to a mental, sensory or other physical dysfunctio n, but to the complicated educational problem (compare Coen de Jong, 1987). In our meaning, we should not speak of a multidisabled, visually impaired child, if for instance the child in question is using a wheelchair, because that child is able to follow the regular curriculum. Having this definition in mind, the place for the required services needs to be a new type of school. Remember: A mentally retarded blind child can hardly be helped in a school for the mentall y retarded because of his blindness and in a school for blind children, he could hardly mak e use of the special techniques because of his mental retardation. In several discussions during this conference, it became obvious that still ther e is no clear, common definition for 'multidisabled visual impairment'. Also, in Germany a stra nge discussion is being held concerning the questions: - who is to identify a person as multidisabled, visually impaired? - which is the best place for providing services for multidisabled, visually imp aired persons?

The consequences of these open questions are that we do not have a common system in Germany for taking care of multidisabled, visually impaired children, youngsters and adults. This means that in a number of German states, there are special facilities for m ultidisabled, visually impaired persons, while other states have a kind of mainstream system w ith special services, and in some states there is no service at all. In some states, the edu cational administration beliefs that there is a need for special access, other administra tions deny this necessity. What you could also think about is whether this meaning depends on th e availability of funds. When we started offering institutional special services for multidisabled, visua lly impaired children, the minds of some parents gradually began to change. Years ago, there was no special law requiring children to attend school, nor any special right for profo undly handicapped children to join a school programme. This situation changed in 1972. There was a clear agreement by all states that a handicap, however severe or profound, wil l not be in any way a reason for refusing a child access to a school system. Some parents had th e idea that "school is a place to learn to read, write, etc." But more and more parents beca me aware of the fact that a school is a field of education, a field of chances for their mul tidisabled, visually impaired children. The self-help associations and the traditional schools for bl ind children felt, at that time, that the major problem of a multidisabled, visually impaired child is not his blindness and therefore not a task for themselves. This understanding changed a long time ago, not in the sense of: 'It is only a task of schools for blind children', but : 'It is also a task!' The meaning does not lie in the location, but in the special service. In the last few years, more and more educational ideas in the educational depart ments in Germany showed a new view on providing special care for disabled people. The com mon idea is not to start by asking where to send disabled children, but by asking for the ir special needs. This means that if a multidisabled, visually impaired child has special needs of improving his vision, he has the right to attend a special programme. This could happen at hom e, in a hospital, in an ordinary school within a mainstream programme, in a school for m entally retarded children, or in a school for multidisabled, visually impaired children where all services, all special help is provided. To summarise this point:

- if it is possible to bring the needed ed, visually impaired child could continue to attend - if the help a multidisabled, visually oo special, it could make more sense for him to attend

services to other schools, a multidisabl his own school; impaired child needs is too extensive, t a special school.

The Blindeninstitutsstiftung in W rzburg provides both solutions, a mainstream sys tem (for blind and partially sighted children in ordinary schools and for multidisabled, visually impaired children in other special schools) and special facilities for multidisa bled, visually impaired children. This is to state that a high percentage of all Bavarian multidisabled, visually impaired children attend our schools, only a small number of them is still remaining in facilities for mentally retarded children. We feel that there should be a better answer from an institut ion for blind people to the questions of providing help for special needs. A lot of questions reaching us from schools for physically or mentally handicapped pupils show and prove that t he process of teaching and educating multidisabled, visually impaired persons often focuses in ophthalmic questions and in very specific questions in the educational field of visual impairment. Obviously, the educational aspect of visually impaired children shou ld always be taken into account. Providing a school system for multidisabled, visually impaired children demands the following conditions: 1) The classes should not be too crowded. In our practice, we provide classes wi th five or six multidisabled, visually impaired children; 2) Individual special needs demand individual special help. That means that this group needs at least two persons, at all times, i.e. a teacher and an assistant; 3) All teachers need to have a university degree in special education (2 years) in addition to a degree as a teacher; 4) A continuing institutional training and improvement - in our institution at l east 40 hours a year; 5) Special needs require special professions. The teachers have to share their r esponsibility for the children with other professionals not normally found in regular schools, such as physical therapists, mobility specialists, occupational therapists, speech thera pists, vision therapists, doctors, social workers and more; 6) A main point: a continuing, consequent and close co-operation with the parent s; 7) The other main point: the special needs require the help of different profess ions. For the

multidisabled children, a multidisciplinary team is needed and a close co-operat ion and exchange between all the professionals of the team. Our institute provides paid working time for this task. Having the special needs of multidisabled, visually impaired children in mind, y ou will feel that providing a school system for these children is not enough. Only a broad sy stem, including: Early education (2 hours a week); Schooling (6 - 21 years old); Vocational training (at least 3 years) Sheltered workshops (lifelong) Residential facilities (lifelong)

will meet the needs of multidisabled, visually impaired children, youngsters and adults. An institution taking care of multidisabled, visually impaired children has to h ave a high level of responsibility: - in organisational and structural realisation - financial resources - team co-operation It is up to these institutions to form an entire special environment based on th e needs of multidisabled, visually impaired children, youngsters and adults. Only if we are able to mobilise all available knowledge and skills of all educational and medical disci plines will we be reliable for these multidisabled, visually impaired children, youngsters and adults.

EARLY INTERVENTION CARE AS A PROCESS By: Mgr. Terezie Hradilkov (Czech Republic) Director of Early Intervention Centres

Firstly, I would like to present to you the schedule of my lecture: I. Introduction About myself About Early Intervention About the Czech program 'Guiding' - goals, principles, team Documentation Feed back

II. Process of EI client find reception of a client parents' needs recognition child assessment comprehensive services - forms of support and therapy interdisciplinary consultations transition to a pre-school programme ending of care III. Summary and recommendation To your disposition are videos, photo documentation, publication of programme "Enlightenment and Public Education I. Introduction About myself My name is Terezie Hradilkov. I have been working with children and families for 14 years. I started this work during my studies of special pedagogy at the Charles Univers ity in Prague. In the eighties, in our country there was a communist regime with very strong se gregation approach towards people with special needs. Therefore, we provided these service s voluntarily until 1989. After political changes we established Early Interventio n (EI) as a professional service. Now I work as a director of the network of 6 EI centres, w hich provide services for families with children with visual and additional impairment. We ar e a nongovernmental, non-profit organisation called the Association for Early Intervent ion. About Early Intervention Nowadays, there exist many different programmes of Early Intervention throughout the world managed by different kinds of organisations and agencies ranging from state to NGOs, from professional to self-help programs. They are home-based, centre-based or a combi nation of both types. They are funded by budgets of Ministries of Health (USA), Education (Sweden), Labour (Germany). The result of the development of EI in last 30 years consists of 3 phenomena: 1. shift from institutions to homes of clients; 2. shift from child-focused services to family-focused services; 3. shift from expert approach (expert - client) to family support (mutual partne

rship). Now, I would like to specify what Early Intervention is. Although I don't want t o bother you with definitions, I start with two: The first one is from Ohio, USA: EI is a system of services and programmes to me et the needs of the child and its family from the child's birth to the legal school age; The second one is from The Czech Republic: EI is a system of services and progra mmes for children with impairments or at risk, and their families. The goal is to minimis e the consequences of impairments and to help a child, its family and society with soc ial integration. EI programmes differ from school programs which children enter late r on. The role of parents and family members during the process of socialisation of ch ildren with visual impairment has become more and more important in recent years. This, in f act, means that there is a process of big changes in contemporary EI. That process correspo nds very well with EI services provided in the Czech Republic. These services are based on the traditional family values. About the Czech programme 'Guiding' (See Appendix: the map of 6 centres EI (370 clients) around the Czech Republic .) The art of home visiting depends on: - following clear goals and principles; - forms and methods; - quality of the team. Goals to help the parents to be self-confident and responsible for the upbringing of t heir child; to help the children minimise the consequences of visual (and other) impairment; to help both parents and children enjoy the process of interactions. Basic principles: to respect the individuality of the child and the cultural, social and education al specifics of every family; to help the parents and children to find their abilities and strength to cope wi th the handicap; to support social integration of children with handicaps and their families.

Team Home visitors (EI counsellors): - special teacher - social worker Vision stimulation instructor Physiotherapist Psychologist Parents Doctors Administration worker II. EI care as a process You have heard that in both definitions of the EI the term 'system of services' was used. Which services are we talking about? When and to whom are they provided? To explain that, I have prepared an overview of the EI services process from fin ding clients to saying them goodbye. Client find EI begins when a client who could need these services is found. I prepared a tab le where it can be seen who recommended our services to clients. Table no. 1: PERSONS WHO RECOMMENDED EI SERVICES TO CLIENTS (Helena Holubov, Mgr,: EI centres in the Czech Republic, 1995, thesis) PERSON, NUMBER, % Parent, 29, 11.42 Other person, 36, 14.17 Local authority, 28, 11.02 Doctor, 119, 46.85 Unknown, 42, 16.54 TOTAL, 254, 100 The 'other person' who recommended EI service was: a member of family (except pa rents), day-care centre teacher, psychologist, physiotherapist in spa, parents of other children with impairment, etc. You can see that most of the clients are coming to us from theirs doctors. Can w e support this phenomenon? Yes, on the condition that 1. we make doctor believe in the importance of EI (use positive examples); 2. contacting us is very easy (use a leaflet which can be given to parents in hi

s surgery); 3. doctor respects us as professionals (visit conferences of ophthalmologists, p ublish articles in special press for ophthalmologists, neonatologists, etc.). Parents and other persons gain information about our service from newspapers, ma gazines or leaflets. Summary: Give a short and clear information about sort of services you offer, ty pe of clients you take care about and where you can be found. Reception of a client We do not accept information about clients if they do not know about it. I regre t having to say that this still happens in our county. If it happens, you have to be very diplom atic, especially if information comes from a doctor who refused to co-operate with you before. Th e parents must be asked whether they wish to be our clients and which kind of services th ey and their child need. The most common way is that the parents are given a leaflet and that they contac t the EI centre directly. After that they are put into the accounting of clients. Discovering of parents' needs During the first visit, it is negotiated which kind of services would meet paren ts needs. If we want to discover parents needs we have to ask simply: - what can I do for you - what are your needs - what services do you consider useful for you family/child Do that before you read diagnosis of the child. Assessment of a child Again start with simple things and with contacting the child. Begin with observi ng child in his natural environment, listen to what parents say about their child. After this th e team assessment, documentation and diagnosis is evaluated. Providing services Table no. 2: COMPREHENSIVE SERVICES - FORMS OF SUPPORT AND THERAPY. Overview of forms of Early Intervention used in our centres in the 'Guiding' programme: Form-- Time Period home-based home visits-- 1x per 1 - 3 months/ client

home visit including consultation-- 1x per 6 months / client lending toys and literature-- 1x per 3 months centre-based one-day courses for parents-- 1x per 3-4 months week programs for whole families-- 2x per year vision stimulation assessment-- 2x per week physiotherapy consultation-- 1x per 2 weeks team assessment-- 1x per year / client mothers meeting-- 1x per months sent by post bulletin for parents-- 4x per year benefits counselling-- 1x per year letters, support letters information-- according to needs accompanying children and parents to doctor, school, day-care centre to local authorities-- according to needs Interdisciplinary consultations Consultations can be divided into: A. About a concrete client

1. consultation inside the team (EI counsellor and physiotherapist, both kn ow the concrete child); 2. consultation outside the team (EI counsellor and co-operating ophthalmol ogist) B. About a specific topic, e.g. problems of visually impaired children with autism. Themes of consultations are chosen according to parents wishes. Do not provide t hem without informing the parents. Parents must also be informed about the results of the co nsultations. Transition to a pre-school programme - mainstreaming: when parents place a child in the common school within the co mmunity. The success of such a placement depends on whether the community feels the child and family as its part. - special programs with handicaps: especially parents with children with multipl

e impairments choose special programs. It is because children are refused in commo n preschool settings or are in need of special rehabilitation. This means that EI services have to 1. support family in its activities within the community, accompany children and parents to the chosen setting if they want; 2. support common settings in admitting children with impairments. (Provide them with information, examples, show them photos, videos, support special training for t he staff). Ending of care Ending of care can be difficult period for the family and the counsellor because they worked together for four up to six years, sometimes they became friends. We leave the c hild in a difficult period of time, when the child is going to school. Documentation All the process of serving clients is accompanied by the same attention to the c hild and the family. (See Appendix: the 'Form of visit') Feedback We choose the method of questionnaire for feedback. If we want to know the deman ds of parents, we have to ask clients about their needs and it is important to know de tailed information about whether our services are still in connection with their demand s. Table no. 3: A SAMPLE OF A QUESTIONNAIRE FOR PARENTS (Milena Jab rkov, Mgr.: Non-expert Attitude Used in EI Centres, 1996, thesis) 1. Parent's interest for EI Services Yes.........................................98% No.............................................1% No decision...............................1% 2. Wishes on frequency of home visits No decision................................2% 1x a month................................28% 1x two month............................35%

1x three month..........................25% 1x half a year..............................7% other wishes................................3% 3. Wishes on visits in regional centre No decision..................................2% Are interested..............................56% No interest...................................26% Not decided yet...........................16% 4. Interest of parents for follow up of the development of the child and interview with psychologist Yes........................................73% No.........................................22% Not decided yet.......................5% 5. Interest in consultation with physiotherapist No decision..............................1% Yes.........................................53% No...........................................40% Not decided yet.........................6% 6. Interest in consultation with low vision therapist No decision................................2% Yes...........................................83% No.............................................13% Not decided yet...........................2% 7. Interest in one day seminar No decision..............................2% Yes.........................................50% No...........................................27% Not decided yet.......................21% 8. Interest in receiving of newsletter for parents

Yes.........................................89% No............................................6% Not decided yet........................5% 9. Interest in one week program No decision.............................1% Yes........................................54% No..........................................24% Not decided yet.....................21% 10. Interest in social events with film performance No decision.............................2% Yes........................................35% No.........................................44% Not decided yet.....................19% 11. Interest in weekend rehabilitation meeting No decision....................................3% Yes................................................40% No..................................................37% Not decided yet..............................20% 12. Interest in parent's club in regional centre No decision.....................................29% Yes..................................................25% No...................................................46% 13. Interest in mother's evening club (without children) No decision......................................21% Yes...................................................21% No....................................................56% Not decided yet...................................2% 14. Number of returned fulfilled

questionnaires in regions: Praha, Liberec, .Budjovice................53% Brno.......................................................21% Olomouc, Ostrava..................................25% But let me end with the words of one of my colleagues from the discussion about the evaluation of our results: "Maybe the best result is when the parents stop needi ng us. I think about it every time, whether it's more sad or nice that they no longer need us." III. Summary and recommendations If I talked too much or if the described process seems to be too complicated, no w I'd like to recommend you simple principles which can be easily followed. This will make the services cheap and effective. Following principles are, in my opinion, the most important : 1) Ask parents what they need and which services will be useful for them. This w ill save your time, work of your experts and make the contact with family easy going; 2) Provide parents with the appropriate amount of information and let them decid e. They will not be dependent on you; 3) All the children need more love than therapy. Despite the fact that you are p rofessional you remain a human being; 4) 80% of children coming to EI centres have residual vision. Help them to use i t, they will be able to help themselves later; 5) When you visit parents with children in their homes don't forget that parents also need contact with other families with similar experiences. Someone else can give them something what you can't; ASSESSMENT OF LOW VISION By: Mrs Lea Hyv rinen, M.D. (Finland) The assessment of vision for educational purposes and early intervention compris es three major areas: 1. assessment of vision of children at school age with low vision but without ot her impairments; 2. assessment of school children with visual impairment and one or several other impairments; 3. assessment of vision for early intervention for pre-school children. Although the assessment for early intervention is extremely important, at this m eeting we concentrate on the assessment of low vision at school age.

The basic questions in the assessment of low vision at school age are: How much vision does the child have for - communication - orientation and mobility - activities of daily life (ADL) and - sustained near-vision tasks. With respect to children with severe loss of vision, there is one more specific question to be answered. We have to find out whether the child has enough visio n to initiate communication. The assessment is based on results of a number of clinical tests, observation du ring these tests and observations during different daily activities. Although vision is a sensory function, its use is based on several motor functio ns. Therefore, during clinical assessment we usually assess motor functions first, then sensor y functions, and complete these findings with observations on the use of vision. The order of observations is depicted in the following flow chart: ORDER OF OBSERVATIONS - the child uses one eye / how _______________________________________ both eyes - is binocular, dominance - alternates,-

- Accommodation, fixation, saccades, tracking, convergence - Strabismus, limited ocular motility - Nystagmus, compensating head postures The first question is whether the child uses one eye or both eyes. If the child has two functioning eyes, is the use of vision binocular or does the child use alternati ng fixation? If the child is binocular, which eye is the dominant one? If the child uses altern ating fixation, the type of alternation needs to be described. Motor functions The motor functions to be investigated are accommodation, fixation, saccades, tr acking, convergence, strabismus and nystagmus.

Accommodation, focusing the image so that it is clear at different distances doe s not develop in all low vision children and is especially poorly developed in children with o ther motor disturbances, cerebral palsy, CP, being the most common condition combined with poor or irregular accommodation. Down Syndrome children are another large group of children in whom accommodation does not seem to develop normally. Accommodation can be measured using either dynami c retinoscopy or by measuring visual acuity at a distance and near by. If near-vi sion acuity is poorer than visual acuity at a distance and near-visual acuity is improved by re ading lenses, then insufficient accommodation is the cause of poor visual acuity at near dista nces. Fixation of gaze, looking at an object of interest, is another function that dev elops early in normally developing infants. Fixation uses either the centre of the visual fiel d, foveal vision, or - if foveal vision is damaged - fixation is based on the preferred retinal lo cus (PRL) that has become the centre of the child's visual field. If the loss of central vision i s recent and the preferred retinal locus has not yet stabilised, fixation shifts from one locus t o another. The preferred retinal locus may change also as a function of luminance level or the text size to be read. The variation in the location of the preferred retinal locus can best be o bserved with SLO, scanning laser ophthalmoscope. SLO has taught us a lot about shifts in PRL . This phenomenon can also be studied with a poor man's technique by mapping the blind spot while the person is fixating texts of different sizes or during varying luminance leve ls. Fixation can be stable, unstable, or there is no real fixation but the gaze wanders without s topping at the objects of interest. The quick eye movements from one fixation point to the next are called saccades. They are used when we scan our environment locating numerous areas of interest. Saccades are the basic motor function when reading. Thus, if saccadic functions are not normal, we can expect problems in reading when the usual reading techniques are used. Tracking, or following of an object with gaze, is based on smooth pursuit moveme nts. They develop during the first year during which eye movements normally differentiate from head movements. Convergence, turning of the eyes inwards when looking at close distances, may be insufficient

in which case it is difficult to keep the images of the two eyes together to cre ate single vision, i.e. one single picture despite the fact that we have two eyes. If convergence is not powerful enough, the images will fuse at near distances and the child sees double. Schoo l children may or may not develop suppression mechanisms to prevent the disturbing other pictur e from getting into image analysis and may need to close one eye or use head turns. Strabismus, squint, is more common among low vision children than it is among ch ildren who have developed normal vision. Strabismus should be treated in low vision childr en in the same way as in non-impaired children. Nystagmus can be benign, inherited motor nystagmus, which is usually combined wi th reasonably high central visual acuity or sensory nystagmus caused by low vision. Quite often the child has learned that in a certain head posture, the amplitude of nystagmus in at its minimum. If the abnormal head posture could lead to changes in the structures o f the neck, prisms and surgery may be considered. Sensory functions Visual acuity is measured with line acuity charts as defined by the internationa l recommendation on measurement of visual acuity. Line acuity means that the dist ance between the symbols is equal to the width of the symbols on that line and the di stance between the lines is equal to the height of the next lower line. This type of v isual acuity tests have symbols in a V-pattern. In some test charts there are more than one set of the lower rows. Visual acuity measured with single optotypes can be several lines better than vi sual acuity measured with a line test. Thus the method used should always be clearly stated . In all testing, it is good to define the test used and the distance applied. Then visua l acuity values give a better idea about the visual sphere within which the child uses central v ision. Near-visual acuity is measured using a near-vision card (Figure 1 A) with the sa me symbols used in the distance visual acuity chart. Near-vision acuity may be better than distance-vision acuity when the child has nystagmus. Often it is worse, in which case near corr ection needs to be investigated. Figure 1 A. Figure 1 B.

When the child is ready to learn to read, visual acuity needs to be measured wit

h a test where the distance between the symbols is half of the width of the symbol (Figure 1 B) . It gives a good approximate for the smallest print that the child can read. It should be re membered that this size is not the print size that the child should read at school. It is the threshold size print. It is advisable to use print that is three to five times larger than the thresho ld. The print size that can be read fluently for a short time and the optimal print size when study ing for longer periods need to be assessed. This requires also the measurement of the visual f ield for reading. Figure 2. Grating acuity is good to measure also at school age if visual acuity is below 0 .03, and in all cases when the child cannot respond in an optotype acuity test. It is especiall y important to measure grating acuity in brain-damaged children. During this measurement, we may learn about other changes in visual function. If the child cannot see the grating whe n it is moved, but can locate and recognise it when it stops, the child is likely to have diffi culties in seeing other objects in motion as well. Contrast sensitivity measurement is not part of the assessment of low vision, no t even in many university hospitals. The measurement is now so inexpensive and so easy and qui ck to conduct that there is no reason not to include it in routine assessment. The op totype tests are non-illuminated charts (Figure 3 A) or back-illuminated translucent charts (Figu re 3 B) that can be used in the same lightbox as the high contrast visual acuity charts. Figure 3 A. Figure 3 B.

Visual functioning at low contrast is important in visual communication and for orientation and mobility. If the child cannot respond to the optotype tests, Hiding Heidi l ow contrast pictures (Figure 4) can be used to evaluate vision in the low contrast domain. Figure 4. The shadows on our faces are close to 2.5% contrast. Therefore, the distance wit hin which the child can see the 2.5% Heidi picture is the space within which the same child ca n perceive our expressions. It is important to demonstrate this distance to the parents, therap ists and teachers, because it is not often known that when a child with low-contrast sensitivity lo oks at an adult he actually only sees a shadow, nothing or very little of the expressions. The c hild's peers should be aware of this problem as well, because children and especially teenage

rs use expressions and body language more than adults. Contrast sensitivity measurement may reveal why a child does not function as exp ected on the basis of the visual acuity value. In Figure 5 there are contrast sensitivity cu rves of three children whom I examined in Estonia a few years ago. Child A had nearsightedness of 15 diopters but moved and played like a normally sighted child. His visual acuity w as 0.3 and his contrast sensitivity was normal at the lower visual acuity values. Child B, who had scars in the corneas and in the retina, behaved like a low vision child bringing small ob jects close to the eyes and moving slowly in the stairs. His visual acuity was 0.3 and his cont rast sensitivity moderately decreased. Child C had not done well in the psychological tests and was thought to be menta lly retarded. His visual acuity was 0.3 but his contrast sensitivity was so low that he most p robably had not seen much of the test materials. Also in his experiences of the environment and in communication he has been severely deprived of information. Thus we have a sample of three children each of whom has visual acuity of 0.3. O ne is normally sighted, one has low vision and the third is severely visually impaired . This example demonstrates that one should always measure visual function at low contrast leve ls. Visual field testing is a demanding test situation. If the child has had the opp ortunity to observe the testing of an older child, Goldman perimetry may be successfully per formed during the first test situation. Often the size of the visual field varies from one measurement to the next even when there is no change in the actual size of the visual field. Th erefore, it is important that, when possible, the measurements are made by the same person, pre ferably by the doctor himself. Automated perimetry is such a difficult test that it can be reliably conducted in older teenagers only. Automated perimetry in conditions such as re tinitis pigmentosa seems to overestimate the loss of function, so the result should alwa ys be compared to the confrontation fields using finger perimetry or small moving targ ets on a pin (Sheridan balls or similar targets). Figure 6 A. Figure 6 B.

When Goldman perimetry is not available, the central parts of the visual field c an be evaluated using the Damato campimeter (Figure 6 A) and the peripheral visual fu nction using

the Nef perimeter (Figure 6 B). This simple industrial funnel is particularly u seful in the examination of pre-school children. The original Nef perimeter is available in Switzerland and its foldaway variant is under construction. The stimulus in Nef perimetry i s a small penlight that is brought close to the funnel surface without causing any noise. It is possible to use small flickering lights as the stimulus and thus measure the visual function that is usually forgotten, flicker sensitivity. Since motion perception is crucial for mobility , all field defects found with the other perimetric techniques should be evaluated using a flickerin g target. This measurement requires further technical development before it is easy enough to u se and thus useful in paediatric assessment. Colour vision is often distorted in retinal disorders, but close to normal when the visual impairment is caused by changes in the anterior parts of the eye. Since in scho ol work colours may carry crucial differentiating information, each child's colour visio n capacity should be known to the teacher. The PV-16 colour vision test (Figure 7) was des igned for paediatric assessment and evaluation of impaired vision at all ages. The surfac es of the colour caps are covered with a thin layer of plastic and are thus less likely to be dam aged by the little fingers than the uncovered Munsel paper used in other tests. The colour surface is large which makes the caps like playthings. The colour stimulus can be reduced to the standard size by using grey rings on the surface. If a double set of the caps is used, i t is possible to evaluate colour deficiencies starting from the age of two years or as soon as th e child has learnt the concept of 'same' related to colours. Visual adaptation changes in a number of retinal disorders. We talk about night blindness but mostly there is no real night blindness in children. Poor visual adaptation mea ns that the time required for starting to see at a low luminance level is longer than in a normal ly sighted person and/or the child is easily dazzled when coming into a brightly lit room o r going outdoors. Measurement of the speed of visual adaptation is a quick and easy met hod to assess retinal function. In everyday situations, cone function is more important than rod function. Therefore, measurement of cone adaptation by using the CONE Adaptation test (Fig ure 8) allows follow-up of the child's visual adaptation to low luminance levels. The t est is possible to conduct when the child is able to sort the blue, red and white chips into thr ee piles. Photofobia is caused by several different changes in the visual pathways. In ac

hromatopsia and in juvenile macular degenerations, often also in retinitis pigmentosa, rod c ells function in day light - apparently because there are too few cones to inhibit rod function and, being much more sensitive than cone cells, are overexposed by daylight. This may make the image disappear in glowing mist. Children suffering from photophobia need carefully c hosen filter lenses (Figure 9) that decrease transmission of bluegreen light that activates r od cells. The filter should transmit some blue light and the long wave lengths. Multi Lens (B ox 220, S-435 25 M lnlycke, Sweden) has manufactured a set of nine filter lenses that absorb at different wave lengths. They come with or without a polarised surface. The polarised surf ace makes the filters pleasantly brown and thus cosmetically acceptable, an important feat ure especially in the teens . There are also dark variants of these lenses. All these different filters are needed in the assessment of children with retinitis pigmentosa like changes in the reti na. In a recent examination of eleven children with Usher syndrome, eight of the nine filters we re used. Only the darkest filter with 550 nm transmission was not felt useful by these te enage children. The day was sunny but the snow was melting and it was not as bright as it can be in March. Thus it is possible that some of these children will find also the darkest filte r useful next winter. Filter lenses have a special quality which is difficult to understand or believe until one experiences it oneself, namely the subjective increase in brightness although mo st of bluegreen light is absorbed and thus less light enters the retina than without t he lens. This happens because rod cells function more normally when exited by a low luminance level at bluegreen light, and millions of sensitive rods are brought to work at the same time as the cone vision is functioning. Photofobia caused by cloudiness of the cornea or lens or by allergic reactions r equires usual absorption lenses that are now available in so many different colours that every child should find a tint that he or she likes. As with the filter lenses, the absorption len ses, i.e. regular sun glasses, should be chosen by the child him- or herself. Low vision assessment also includes fitting of low vision devices and observatio ns on the child's visual function during daily activities and orientation and mobility. S hort working distances lead to poor posture if ergonomic questions are not solved. The effec t of the child's visual capabilities with respect to each school subject should be assessed so th

at teaching techniques and study materials can be chosen to meet the child's needs. This re quires good co-operation between the low vision team and the teachers and parents of the chi ld. Conferences like this one in Ankara which bring together medical and educational personnel will improve mutual understanding and develop a language that is common to both groups. Additional information is available at: http://med-aapos.bu.edu/leaweb/index.html http://www.lea-test.sgic.fi POSSIBILITIES OF INTEGRATED EDUCATION By: Mr Stef Pennings (The Netherlands) Co-ordinator at the Educational Institution CONVERGO

Ladies and gentlemen, It is both a very great honour and a very great pleasure for me to be invited by the Federation of Associations of the Blind in Turkey to lecture at this national conference on the Education of the Visually Impaired in Turkey. And, it was a great pleasure for me as well to have the opportunity to visit the schools of Mr Yilmaz and mr G ler in Istanbul last Thursd ay. As a man of practice, it was an eye-opener and the best way to start my visit to this conference. I hope that this conference will give an extra impulse to the development of speci al education for the visually impaired in Turkey. I would like to start my contribution by quoting an American colleague: "One of the qualities of being human is the ability to give and to receive suppo rt. None of us is 'independent' in the strict sense of the word. Our independence de pends on the networks of support we build around us" (Kate Moss/TSBVI Deafblind). In terms of support within the network of visually impaired, I would like to dis tinguish the following target groups: -Parents need support from medical and educational professionals: they need to u nder-stand the diagnosis their child receives and they need support in understanding the sp ecial education process. They also need support from other parents of children with the same dis abilities: to exchange information and courage and to form an idea of what tomorrow might brin g for them. -Grandparents, siblings and other family members need support too. Like the pare

nts themselves, they need information, understanding with respect to their own feeli ngs and thoughts about having a family member with a disability. -That children and young people with visual impairment need support seems obviou s. They need support from their own family, friends, classmates and teachers to make the m feel an accepted part of their community. But they also need support from specialised te achers they can rely on. -Professionals need support as well. If you will allow me to address all of us t oday as professionals in the field of visual impairment, I would like to make it clear t hat we in turn all need support from the families and people with visual impairment. We need suppor t to learn new skills and to develop new techniques. We also need support to acknowledge th at we do not have a ready-made answer to all the questions and problems that might occur. We need support from our colleagues who are also faced with the same questions. As profe ssionals we also have our duty to those people who are responsible for developing legislatio n. -Legislators, local or regional governments, civil servants need support in prep aring and making the right decisions for the visually impaired children and their parents e.g.: - guarantee the availability of special education programmes; - financially assist the efforts of regional or local governments to educate chi ldren with special needs. We all need to feel at ease with asking for support and we should be able to off er support to those around us. None of us can really go it alone. You can work by means of a f ormal support group, such as colleagues, university courses, conferences, study visits , or by means of sharing your questions with a friend or a relative; in both ways the goal is to build circles of support to improve life for everyone, and, in our profession, to improve life fo r visually impaired pupils or students. Today, I would like to offer my contribution to such a circle of support. I am w ell aware of the fact that my situation in the Netherlands is quite different from the situat ion in Turkey. Therefore, I will not present a lecture here about "the best way" or "the ultima te answer to all your questions", because in my country, we are in the ongoing process of develop ing our circles of support as well. I just hope you will be strengthened by the ideas yo u will hear this

week - in lectures and in private talks- and will have the opportunity to incor porate these ideas into your present body of knowledge and experience. With all our differenc es, with the possibilities and facilities of our own country, we have to set up and develop o ur own networks, but by co-operating we can share the knowledge each of us possesses. Schools for special education as the basis of all support. Just as in The Netherlands, special education of the visually impaired in your c ountry dates from the last century. In Turkey, it was the Minister of Education Munif Pasha w ho founded the first school for the blind in 1889. In Europe too, the education of blind ch ildren developed from institutionalised care for the handicapped in general, towards the end of t he last century. The following years of this century saw the added development of special educati on for partially sighted children. In the times behind us, many people achieved very good results, with the means a vailable to them at that time. Attitudes towards people with handicaps changed in a positive way. With the knowledge and possibilities available in past times, teaching methods and sp ecial aids were developed for blind and partially sighted children. In our time, we are con tinuing on the basis of the knowledge and experiences of our predecessors. Of course, I do not intend to discus the entire history from the last century till now. After all, this confer ence has been organized with the aim of taking close look together at the future of special ed ucation of the visually impaired. My experiences and ideas, which I will present to you today are based on my work as a teacher within regular secondary education, as a special teacher for the visuall y impaired during a period of seven years, my experiences as an itinerant teacher in second ary education during a period of 8 years and my position as a co-ordinator of courses and itin erant educational assistance for the visually impaired today. One of the articles of mr Herman Gresnigt, which I was allowed to use for my pr eparation for this introduction, says that the teachers at the schools for special education o f the blind education of partially sighted pupils followed later - have been the pioneers in the development of the integration of visually impaired pupils into mainstream educa tion. In the seventies, they have paid good attention to the question of a number of p arents who preferred to send their child to a school in their own village or town, so that their child could

live at home like other children. With the relatively short travelling distances in The Netherlands, it soon turne d out that this question could be answered positively for a number of children. This marked the beginning of the development of integrated education in our country. Later this morning, I wi ll return to this in more detail. I share the opinion of mr Herman Gresnigt, and of many other Dutch colleagues, t hat the itinerant - educational assistance of visually impaired pupils should be based on qualitatively well-functioning school for special education. In my view this applies to the vi sually impaired, but to the hearing impaired and the physically impaired as well. It go es without saying that the government and social tendencies have played an important role i n this as well. In Turkey too, I do not think it will be hard to find highly motivated people wh o are prepared to devote themselves to the education of handicapped children and who want to ma ke an effort for the development of special education. But good ideas and heart-felt m otivation alone are not enough; in consultation with experts and people from the target gr oup, the government will have to aim for clear legislation and for finding the possibilit ies to support the developments with adequate funding (equipment of schools, training of specia l teachers, creation of the facilities for special aids). In The Netherlands, the Ministries of Education, Social Affairs and Public Health play a joint role in this matter. Of course I understand that statements such as these cannot be turned into reali ty in the short term in your country. But perhaps it will reassure you to know that other - Euro pean countries needed quite some time before special education arrived at its present level. I think that this is a development which will never reach its final destination; the inf luences of technology, and the ever-changing insights within education and the upbringing o f children, will keep it an on-going process. Just now, I have indicated that the idea of integration originates from special education. I hope that, during this conference, I will gain more insight into the development of s pecial education in your country. On the basis of experiences in other countries, I still think I can state here that thinking about integration of the visually impaired into mainstream educati on is on the increase, the more children, parents and teachers are confident of a "safety net " in the shape

of a school for special education or, at a later stage, a Resource Centre. Expertise of special schools: a reliable base for integration. The educational quality of these schools for special education is expres sed by: -the development of special teaching methods (didactics); -the development of special teaching material; -the development of special aids; -its being a centre of knowledge and experience with respect to visual impairmen t; -training and coaching of special teachers and itinerant educational assistants; -guidance and support for families; -advice, guidance and support for local, regional and national government offici als and politicians; -co-operation with other services (e.g. social services, ophthalmologists and he alth centres). I would like to offer you some insight into the various types of integration of visually impaired pupils into mainstream education. These various types are well describe d as steps of good practice in literature and by means of lectures on meetings about visual i mpairment in the past years. The goal of every described type of integration is to educate v isual impaired pupils together with seeing classmates in their own environment and if possible on a mainstream school. Models of - integrated - special education for the visually impaired. Basis: Schools for special education with a boarding-house? no integration. - Sighted pupils integrated into a special school for visually impaired children ; - "Guest pupils" from special schools for visually impaired children in mainstre am schools; - Visually impaired pupils visiting a mainstream school for one or two days; fro m being a guest, a pupil can gradually develop into a fully integrated pupil; - Visually impaired pupils integrated into mainstream education as much as possi ble, by means of "resource classes" with specialised, integrated staff; - Visually impaired pupils integrated into mainstream schools with the help of p art-time specialised teachers and mainstream teachers in one class; - Fully integrated visually impaired pupils with support on a distance from a Re source Centre and with teachers who followed special courses; - Fully integrated visually impaired pupils with itinerant support close at hand and the

special school as a Resource Centre. As I said before, each country makes the choice best suited to its own situation : referring to its historical background, the organisation of the national education in general, po litical possibilities, distances, infrastructure, financial possibilities, co-operation with parents: all play an important role. Based on my own experience I am convinced that within the group of visually impa ired pupils, a number of pupils will remain dependent on special education; some for a short time and some for their full school period. Various reasons can underlie this: *children who become partially sighted or blind at a later age and consequently need to learn braille and writing within a very short time, for instance; *children with severe learning problems in addition to their visual impairment; *children with serious behavioural problems in addition to their visual impairme nt; *children who are functioning on a low level in addition to their visual impairm ent; *children who are only eligible for integration at a later stage of their develo pment; *children who get stuck in mainstream education and who will temporarily benefit from special education. In other words, the facilities for special education and integrated education wi th support of itinerant teachers are in line with each other and link up perfectly in case suc h is necessary. It follows that most special teachers who will work as itinerant teachers in the fu ture will remain 'special-education-based' or will receive their training from a Resource centre. Together with their colleagues, they will control the continuous process of the development and assistance of the education and upbringing of blind and partially sighted ch ildren. In a town or a region, they will jointly form a source of knowledge and experience fo r everyone who comes in contact with a visually impaired child. With the greatest respect for what has been developed in Turkey up to now, I hop e that my lecture, on the basis of my day-to-day educational practice, has provided you wi th a number of ideas, which we can also discuss informally these days. In my second contribu tion of this morning - together with one of your countryman - I will work out the model of in

tegrated special education in The Netherlands. I also would like to express the wish that this conference will give a positive impulse to the development of care for visually impaired children in your wonderful country. We as foreigners hope we can add some of our ideas to the development of the long-rang e master plan of the experts in your country. I am very honoured you have taken the time to listen to me; I wish you a lot of mutual inspiration in your own part of this development. Hopefully, my contribution will help you further on the right way. I thank you very much for your attention. DEVELOPMENTS IN THE - INTEGRATED - EDUCATION OF VISUALLY IMPAIRED PUPILS IN THE NETHERLANDS By: Mr. Stef P.M. Pennings (The Netherlands) Co-ordinator at the Educational Institution CONVERGO

Ladies and gentlemen, This morning, I have already spoken to you about the possibilities of education. I am very honoured to have the opportunity to inform you in my second on about the developments in special - integrated - education of visually impaired The Netherlands, referring to the educational institution for visually impaired pupils I am working for this institution as a staff member and as an itinerant teacher in education. integrated contributi pupils in CONVERGO. secondary

You are probably all aware of the fact that in comparison with Turkey, The Nethe rlands is a rather small country. The number of Dutch inhabitants is about 16 million. The t erritory of Turkey is about 18 times as large as the territory of the Netherlands. By car or train, we can reach each part of our country within no more than three hours travelling. The c ountry and the cities all have a well-organised infrastructure. I tell you this, because I thin k it is important to keep in mind when talking about the organisation of special education and when t hinking about the organisation of resource centres or itinerant teachers visiting mainst ream schools on local or regional level. Like I said this morning, you have to deal with the ava ilable possibilities and facilities in your own situation, so I tell you now about the Dutch situation. Distributed over our country, about four different organisations are working wit h visually impaired pupils aged from 4 to 21. All of these organisations still have a small boardinghouse, special schools for blind and partially sighted pupils, course centres an

d departments with itinerant teachers. At the moment, these four institutions together support about 2,000 children and youngsters, either at one of the special schools or by means of sup port by itinerant teachers. The educational institution CONVERGO is situated in the southern part of The Net herlands. The Netherlands know regional centres, a national vocational centre and a nation al centre for non-educational support as well, but in my contribution I will limit myself to t he educational provide of our work. In this brief explanation, I will tell you about the developments in integrated education in my country and I am very proud to I have the assistance of mr Halit Yurdusen, one o f my former partially sighted pupils, who will address you in Turkish after my lecture. He i s an example of a partially sighted pupil who attended primary and secondary special education o n the Convergo institution and received itinerant support during the period of the dev elopment of integration in our country. I think he can tell you much better than I about his experiences as a partially sighted pupil during this developmental stage. Together with you, I am looking forward to his contribution, but first you will have to do with me for a little bit longer! WHAT IS ITINERANT EDUCATIONAL ASSISTANCE? Itinerant Educational Assistance is additional support for visually impaired pup ils, to enable them to attend mainstream education instead of special - secondary - education, which would have been the case without such support. This assistance is provided by speciali sed teachers from educational institutions such as CONVERGO in a Dutch town called Grave. Tea chers working in this particular field of education provide assistance at several scho ols in a particular region and hence are called itinerant educational assistants. Itinera nt educational assistance is a very flexible form of service and can be classified as 'tailor-m ade assistance', in which the child's possibilities and the wishes of both parents and school are ce ntral. A BRIEF HISTORY Like I lectured this morning, the care for blind children in The Netherlands dat es from the last century. In the early seventies of this century, however, the demands of parents started the development of extramural care for blind and partially sighted children and youn gsters. At that time, mr Herman Gresnigt was one of the initiators of this development i

n his capacity as the director of an years he spoke about this subject in care, this development grew from bringing up children at home, and

institution for visually impaired children, and in recent different lectures. In addition to traditional intramural the increasing appreciation by society of the benefits of this applied to visually impaired children as well.

In the second half of the seventies, the Dutch Ministry of Education prepared me asures to pave the way for the provision of assistance to visually impaired children in ma instream education. In 1985, itinerant educational assistance for virtually all special s chools was provided for in the Special Education Act; this included assistance for blind an d partially sighted pupils in primary and secondary education (from 4 to 20 years of age). In the Netherlands, the decision was made to manage this integration by means of the schools for the visually impaired. These schools had the experience with and know-how ab out specialised education for partially sighted and blind children. Only part of thi s knowledge and experience can be found in books. In my opinion, it should be looked for in peop le who are actually working in this field. In my country, therefore, the first itinerant te achers had their roots in special schools for the visually impaired and, throughout the last 20 y ears, shared their knowledge with their colleagues in the mainstream schools. The special sch ool will remain their basis, e.g. in my case this is the educational institution CONVERGO , where I am a member of a multi-professional team of specialised teachers, braille experts, social workers, mobility trainers, low vision specialists and other specialised colleagues. At this moment, approximately 1,250 visually impaired pupils in primary and seco ndary education, as well as in other forms of special - secondary - education in The N etherlands, 570 of which are CONVERGO's pupils, are assisted by the itinerant educational as sistance service. TARGET GROUPS The assistance an itinerant teacher can provide is intended for: * visually impaired pupils in mainstream primary and secondary education; * visually impaired pupils in other forms of special - secondary - education, e. g. children with learning and behavioural problems; * visually impaired students in junior and senior vocational education; * the parents or guardians of the pupils in question;

* the individual teachers or teaching staff of the schools concerned. INTEGRATION INTO MAINSTREAM EDUCATION CONVERGO's aim is to enable as many visually impaired children as possible to re ceive education in a mainstream educational setting. It is essential for the education of visually impaired children and youngsters to grow up with sighted children of the same ag e group and thus learn to cope with their visual handicap and discover their limitations as well as their possibilities. The objective of a multi-professional team is to develop all nece ssary skills for independence, including the ability to function in a group, self-help skills, or ientation and mobility, and reading and writing in an appropriate way. AVAILABLE TIME On the basis of the recommendations of the Board of Investigation, the school de termines the number of hours the itinerant educational assistants from CONVERGO can devote to actual assistance. The frequency and intensity of assistance for a pupil in mainstream education is determined on the basis of these recommendations. The assistance time includes t ravelling time, administration, organising courses, etc.. THE BOARD OF INVESTIGATION This Board should always consist of the following members: * the principal of the school; * a social worker; * a child psychologist; * an ophthalmologist with specialist knowledge. THE ASSESSMENT The parents or guardians of a visually impaired child can apply for itinerant ed ucational assistance to the Board of Investigation. Other persons or organisations in char ge of a visually impaired child can also apply for assistance, with the permission and co-operati on of the child's parents. After the application, the child is thoroughly assessed. This u sually takes place at the main centre. The assessment generally lasts a full day and consists of: - an ophthalmic examination; - a psychological assessment; - a pedagogic/didactic assessment;

- the social worker's report. On the basis of this assessment, the parents of a pupil or student are advised o n the best form of assistance for their child: - their child stays in the mainstream school and receives itinerant assistance a nd, if necessary additional support; - their child is better off at the special school for visually impaired children and, in some situations, will live at the boarding-house; - their child attends the special school for a short period only, to learn brail le for instance, - and will be yearly examined to go back to the mainstream school. The parents receive a verbal as well as a written report on the findings. The fi nal decision about the proper type of assistance and where this will be provided lies with th e parents. JOB DESCRIPTION OF THE ITINERANT TEACHER The itinerant teacher is active in three areas: * pupil and school; * parents; * other organisations. THE AREA OF 'PUPIL AND SCHOOL' Because of his expertise in the education of visually impaired pupils, the itine rant teacher can play an important role in the integration of these pupils into mainstream educat ion. The role of the itinerant teacher is mainly advisory and is intended as an advice from co lleague to colleague for the school attended by the visually impaired pupil. Because of the assessment or otherwise, the itinerant teacher is informed about the eye defect of the pupil concerned. This enables the itinerant teacher to give the pupil con cerned and/or its teacher practical advice on how the pupil can cope with his/her handicap in the classroom. By means of observation in the classroom and by working and talking with the pup il and class teacher, the itinerant teacher can determine how the pupil is functioning at any given moment. In relation to the teacher and staff team, the itinerant teacher has an informat ive role concerning aspects of visual impairment or blindness in general and for this pup il in particular. In addition, he often provides clear information on statutory regula tions, facilities, aids and educational possibilities. Every year, the CONVERGO and Theofaan Course Centre organises courses for pupils under the itinerant educational assistance scheme, as well as counselling courses for

these pupils' teachers from mainstream primary and secondary education. The organisation and realisation of the courses is done by the itinerant teacher s and other specialised members of the institution. By means of providing information, instr uction and the training of skills, they try to create conditions such that visually impaired pu pils will be able to function better in mainstream schools. Another aspect of the itinerant teacher is to instruct the pupil and/or teacher in the use of specific aids. In addition, the itinerant teacher teaches braille, if required. THE AREA OF 'PARENTS' The itinerant teacher explains the parents about the recommendations he has to t he school. While doing this, he also discusses the specific eye defect of their child and e xplains general issues concerning visual impairment or blindness. Should instruction be required with respect to the aids used at home, the itinerant teacher is the person to turn to. For sp ecial instructions such as cane walking, the itinerant teacher calls in the assistance of specialis ts. This specialised staff can provide this type of training over a particular period of time. The CONVERGO and Theofaan Course Centre also organises courses for parents of as sisted children, mainly dealing with practical and pedagogical matters related to the c hild's visual handicap. The informal contacts between the parents themselves forms an importan t added value of these group meetings. THE AREA OF 'OTHER ORGANISATIONS' During the period of educational assistance, the itinerant teacher will have to deal with all kinds of organisations which are involved with his pupil, in one way or another, for a longer or shorter period, directly or indirectly. If one of these organisations is directly involv ed with his pupil, the itinerant teacher's main role is to provide information. The information in ques tion will primarily be related to the pupil's particular eye defect and its practical consequences. Of course, this is always done after consultation with the pupil's parents. I hope this brief explanation has provided you with a clear picture of the activ ities of an itinerant teacher in The Netherlands. Now I will ask your attention for my former pupil, who is presently a senior stu dent in Law, mr Halit Yurdusen. When he attended my lessons in 1985, I could not possibly hav e any idea that 13 years later we would be together in your wonderful country to share our

experiences with you. Ladies and gentlemen, thank you very much for your attention. And now a warm app lause to mr Halit Yurdusen! COOPERATION BETWEEN PROFESSIONALS By: Mrs C.R.A. van Dijk (The Netherlands) Educational psychologist

Introduction This conference is a very good example of co-operation between professionals. Te achers, educational psychologists, ophthalmologists, policy makers and managers are ex changing their knowledge and discussing their opinions. This is a starting-point of co -operation in actual practice. 'Multidisciplinary approach to early intervention' was one of the topics yester day. In this lecture, I will elaborate on professional development and professional co-opera tion. I will demonstrate the quality of interdisciplinary co-operation. I will show the oppo rtunities from different perspectives: from the perspective of the child and its parents, from the professionals, and the perspective of the organisation. I will speak about this subject in the context of some historical milestones in the Netherlands, the needs of child and parents and professional differentiation. But let me first introduce myself I am a special psychologist by profession and for years I worked in special educ ation and the rehabilitation of visually impaired children. For years, I was involved in teac her training for special education. Nowadays, I am the head of the research and development depar tment at Theofaan. Historical milestones Of a two-century history of special education, I will only mention some of the developments during the last 30 years in the Netherlands. There will be some similarities to and differences from developments in other West-European countries. About 30 years ago, we real ised that the education in special schools and boarding-houses was not well adjusted to t he emotional, the perceptual or other individual needs of children. In particular not to the v isual needs of the low-vision children.

-In the sixties, separate schools for partially sighted pupils were founded. Her e, children could follow an educational program adopted to their visual capabilities. Atten tion was paid to optimal visual development and the use of low-vision aids. -In the seventies, guidance and support of children in the regular school system was started off. Integrated education of partially sighted children was very successful. Iti nerant teachers where assisted by a staff consisting of an ophthalmologist, a social worker, and an educational psychologist. By that time, early intervention had matured into an adequate syst em which met the needs of parents in bringing up their young children. The team consisted of a home intervention worker (home visitor), a social worker and an educational psycholog ist. Because of early education, children were better prepared to dealing with a regular scho ol system in their neighbourhood. -In the eighties, integrated education was organised for blind children as well. At that time, early intervention, home and regular school intervention was granted a legal bas is. A reorganisation of the care system for the blind and visually impaired of all age s took place. Regional centres for support in education and rehabilitation were founded. -In the nineties, the separate schools for blind and the partially sighted wer e hindered in their educational organisation. This was caused by the very small number of chil dren visiting special schools. From then on, the organisational division between schools for t he blind and schools for the partially sighted was abandoned and an integrated school system for visually impaired children was founded. This integrated school had to meet all different educational needs of blind and partially sighted pupils, in special or regular schools. Spec ial schools as resource centres. In the mean time, a lot of expertise was developed to meet the special needs of children and their parents. All this time, a close co-operation existed betwe en services of the health-care system and the educational system in each region of the country. -At present, we are confronted with the challenge to develop a flexible system b y means of which we can afford to offer optimal expertise to parents, children, the family system, the regular school system and to other institutions caring for the visually impaire d. If special care and education has to be adjusted to the individual needs of each child in its educational context, professionals have to develop inter-disciplinary and interinstitutional

ways of co-operation. This is what the transition process means, a change toward s a clientoriented attitude of our services targeted at our client's needs. Below, I will elaborate on the development of expertise and professional differe ntiation, but I will start with the needs and questions of parents and children or other clients . Questions and needs of children and parents Parents will first of all try to solve their problems in their own family settin g. The support from their own environment is crucial. In case of visual impairment, timely det ection, diagnoses and subsequent referral for treatment are very important. Medical trea tment can prevent blindness or ambliopia. But medical treatment cannot solve developmental or psychosocial problems. Therefore, the ophthalmologist in hospital has to be informed about the developmental needs of the child. Only when he is well informed about and convin ced of the child's needs, he will refer and co-operate with the care or educational system. Visual impairment can be a risk for the development of a child. Its parents need information about the facts and prognoses of the impairment. They want to know the consequen ces for the development and educational needs of their child. Parents, and later on the chi ld's teacher, want to be informed about how to treat the child in order to optimise its develo pment. This implies adapting their communication and the environment to the perceptual capa bilities of the child. Parents have a lot of questions: could some kind of surgery improve our child's vision, how should I tell my relatives, how will our child learn to be independent, why doe sn't he start to crawl, why is it so difficult to make him to play, can he read print or does he have to read Braille? Is he perhaps mentally retarded as well? will visual training do anythi ng for the better, why are glasses of no help? Questions about their child's future adult l ife could be: for what job can our child be trained, will he/she marry and have children? Question s will come and go during development and parents will want to be informed about these subje cts more than once. To listen to and to discuss these questions requires a lot of empathy . But a lot of expertise is required to answer these questions about their particular child. B ased on professional information and advise and a sound educational plan, parents can m ake their decisions. Professional development and professional differentiation

For answering the questions and meeting the needs of both parent and child, many professional disciplines are involved in assessment and intervention at present. I will review some of the professional disciplines that play a role in this res pect. -Many of medical specialists have to co-operate on diagnosis. When medical speci alists such as paediatricians, geneticists, ophthalmologists or psychiatrist work together, rare syndromes can be identified. In special schools and later on in early education, a staff of specialists has g radually been developed. -The ophthalmologist: a well-known person in special education. In the beginnin g, his role was rather small. I call it a gate-keeping model. The ophthalmologist stated the child suffered from serious visual impairment and, based on that statement, the child could ent rance special education. Gradually, the ophthalmologist can become a partner of the teacher o r home visitor. The ophthalmologist will talk to parents and their child and act as a bridge to the medical care system in the hospital. The ophthalmologist will offer the medical information to the team; -The pedagogue or educational psychologist assesses the child to determine his l earning potential, or to explain learning problems, to obtain an idea about the impact o f the child's visual impairment on its development, to advise parents and teachers; -The low-vision specialist assesses the visual functions and advises the use of low-vision aids; -The speech therapist assesses the child's speech development and starts treat ment if necessary; -The physical therapist advises about how to develop normal posture and gait. This situation can be characterised as a multidisciplinary model. Each professio n has its own object of assessment, its own professional education, its own ideas about its re sponsibility, its own scientific body of knowledge and professional language. Each professional ha s its own assessment and intervention tools. This model has been very useful for developing expertise. But these different go als and different languages might create a problem. The parents are advised from differe nt

perspectives, or are told what to do from different professional perspectives. I t could happen that parents or the teacher received unasked-for advise, mutually exclusive or e ven incomprehensible. I will give you a typical Dutch example. A low vision child in Holland wants to cycle just like any other child. The pare nts ask advise about how to handle their child's wish in a safe way. They see the child enjoyin g cycling in the backyard and are asking how their child can cope with traffic in the street. The ophthalmologist will forbid cycling because of lack of vision. The physical ther apist will state the child can cycle if his balance or propriocepsis is trained, the psycho logist will worry about his hyperactivity. With these divergent statements, the parents problems a re not solved. The parents will ask: tell me how I should handle the situation in daily life? P arents will ask: within which boundaries can my child cycle, how can the child be instructed like other children to move in traffic, how do I handle this prohibition. The same applies to questions about complex situations as: the best reading medium, handling behavioural prob lems, etc. To answer the real questions, professionals have to stop their monologues. Toget her, they will orient themselves on the questions, together they will use their expertise for meeting the real need. Professional co-operation or professional integration This level of co-operation can be identified as interdisciplinary co-operation. Different professionals together will answer the questions and needs of parent a nd child by sharing knowledge and opinions. E.g., if you want to know whether visual trainin g will be of some help, you need the opinion of the ophthalmologist, the assessment results will indicate whether progress can be expected. E.g., when an ophthalmologist advises Braille, it could happen that the teacher sees the child is doing well in print. If you want to kn ow what will be the right reading medium, you need to assemble a lot of information about the vi sual status, the use of aids, the visibility of the material and the developmental level or r eading readiness. Some aspects of interdisciplinary co-operation: -Attitude: -In a client-oriented attitude, the professional expertise is really oriented to ward clients' needs. The needs of the client is the common goal;

-Participants respect the added value of other disciplines. -Special form of communication: -Different professionals have to share a common language or at least understand the professional language of each other; -Going beyond the limits of professions, this is not always easy. It can be done with insight and has to be done carefully and with respect; -to reach this form of communication, one has to be educated in this way. Argume nts are more important than hierarchy. -Responsibility and participation -Each specialist is responsible for its own professional level, but together the team is responsible for the advise and the quality of the educational plan; -You have to invest in this form of co-operation, only then will synergy be real ised; -Participation: each team member needs an amount of knowledge to share the knowl edge of other disciplines. Participation of parents can be enhanced. -Organisation -Interdisciplinary teams can choose a form to organise the communication with pa rents; -Management has to create favourable conditions for the development of expertise and for fostering communication; -Professionals have to be educated in this way. -Interdisciplinary co-operation is hampered by: -opinions about hierarchy; -financial or organisational boundaries; -opinions about professional identity and defining professional expertise; -Professionals are self-defined, but are also defined by the organisation and ot her professionals. Professional co-operation not only within but also across organisations The client can also be another organisation. There are a lot of places with chil dren who have visual problems: in the rehabilitation centre or in centres for mentally retarde

d. Professionals in the field of education in blind and visually impaired children can use this e xpertise beyond the boundaries of their organisation. Co-operation between organisations can be very difficult because of a lot of reasons. In the Netherlands, and I suppose in many European countries, many bridges still have to be built. Conclusions Reviewing these disciplines and the richness of the co-operation, I arrive at th e following conclusions: 1. Each organisation has to define its own view and methods of intervention wit hin the context of societal and political structure; 2. leading principle is the optimal development of the child and well-being of t he child and its family; 3. the scope of assessment and intervention is the bio-psycho-social unity of th e child in his educational context; 4. this means that several professionals should join their knowledge and expert ise; 5. co-operative attitude and submission of the own professional ideas to a commo n goal; 6. Increasing professionalisation, discussions between disciplines will make it possible to realise integrated care; Summary Children with visual impairment and their parents demand professional assistanc e. The aim has to be directed at optimal development and quality of life of both c hild and parent. This statement is of universal value, its content is determined by his torical and cultural context. Anyhow, child and parent want and have the right to professional advise, assista nce, education or rehabilitation. By sharing knowledge and experience, more can be do ne about diagnosing and treating impairment and disabilities. By education and rehabilita tion in a special or regular setting, handicaps will be prevented. By means of co-operation with parents and co-operation between professionals wi thin and across organisations more can be done about the development and conditions of l ife of the visually impaired. Knowledge and expertise should not widen the gap between consumer, client and professional. The right attitude and the working model can be a bridge between parents, consumer and professionals.

Co-operation is considered from different perspectives: from the perspective of the child and its parents, from the perspective of the professional and the organisation..