This presentation was part of a panel for the National Council of State Agencies for the Blind (NCSAB), April 25, 2007 in Bethesda, Maryland.
The topic of the panel was "O&M Options." Panelists were asked to talk about "Structured Discovery Learning" vs. "Traditional O&M" ("traditional O&M" was considered to be mainstream O&M).
Panelists (in the order of presentation) included: James Omvig, Rehabilitation Consultant, National Federation of the Blind;
Dona Sauerburger, COMS, Maryland;
Maurice Peret, NOMC, O&M Specialist, Virginia Rehabilitation Center;
Margaret Stroud, COMS, Supervisor for Independent Living Service and O&M Instructor, NJ Commission for the Blind and Visually Impaired;
Matt Cornelius, COMS, O&M instructor, Services for the Blind, Connecticut;
Ed Kunz, Director, Criss Cole Rehabilitation Center, Texas Blind, Texas;
Melanie Brunson, Executive Director, American Council of the Blind;
Dr. Fredric K Schroeder, NCSAB Policy Advisor, Virginia.
"Traditional" O&M in the Modern Environment: Hallmarks of a Quality O&M Program
Dona Sauerburger, COMS
The "traditional" O&M program was developed for soldiers who were blinded in World War II. It had many features that remain unchanged in modern O&M programs, such as
teaching people to safely travel to unfamiliar destinations independently, including familiarizing themselves to the environment and assessing intersections (determine the geometry of the intersection, what kind of traffic control is there and how best to cross).
teaching problem-solving, including drop-offs (these drop-offs are not exercises in soliciting aid, but rather the clients are disoriented in familiar areas and must figure out where they are without any assistance; drop-off lessons were originally developed by Russ Williams around 1950 after he had been dropped off at the wrong house -- click here for more history of the drop-off lesson and a link to more O&M history)
However there are features of the traditional O&M program which differ from today's mainstream O&M programs, and make the original O&M program more closely resemble "structured discovery learning" O&M programs. These features were appropriate for the traditional O&M program because it served a very homogenous group of people -- all the clients were suddenly, completely, and permanently blinded. These features were that:
the program emphasized non-visual techniques exclusively;
the program did not address the use of functional vision; and
the instructors agreed on uniformity of the techniques being taught because each client might be taught by several instructors and the needs of each client were very similar.
For the first several decades of our profession, even after this traditional core O&M program was adapted to serve children, elderly people, and people with multiple disabilities -- the majority of whom had functional vision -- these non-visual O&M techniques were all that we taught. Blindfolds were used extensively to help clients learn the non-visual techniques, because we only knew how to teach people who were totally blind.
It was not until the mid 1960's and early 70's that some of the more progressive O&M specialists started to question traditional O&M and develop programs to teach people to use both visual and non-visual information to travel efficiently. These programs were resisted by the majority of us O&M specialists. I remember this very well because it was at this time (1969) that I first entered the field, and I got to know one of these pioneers as she endured the resistance of our profession to these "newfangled" ideas. As a result, another decade passed before these innovative programs were published and started to become accepted as best practice.
So rather than tell you about the "traditional" O&M program, I'll talk very briefly about what is considered best practice today by the mainstream O&M profession after having moved beyond the traditional program. I will then talk about optimal use of resources to provide quality, effective O&M services that help your clients reach their goals.
Best practice:
In the mainstream O&M profession, it is not easy to define "best practice" because there is no one system of teaching O&M which everyone agrees to use. Instead, there is a wide variety of instructors and clients, and teaching strategies are used that maximize the abilities and strengths of the client and the instructor. However, the AER O&M Division, which has more than 1300 members, has developed a number of position papers that have the consensus of the profession (this is no small feat, given the diversity of the membership!). Some of the topics of consensus are:
I will talk about two of these issues:
Best practice: Blindfold training
Clients with useful vision need to learn four things, one of which is
Learn non-visual techniques and how to trust the non-visual information.
It takes time to build up trust in non-visual information -- the cane can not be a reliable source of non-visual information until the client has had sufficient intensive training in its use (see "Stages of Learning to Use a Cane"). For example, one woman with retinitis pigmentosa carried a cane in the subway because her blind friends had showed her how to use it and told her it would provide her safety, but she fell off the platform because she hadn't had enough training to achieve proficiency (she then sought and received O&M training).
Some say there is only one way to teach people to use non-visual information and techniques, and that is with blindfolds. Anyone who thinks that there is only one effective way to teach a given skill to everyone just hasn't made enough effort to come up with other ways. The fact is that there are other strategies for teaching the use of non-visual information, including partial occlusion and intermittent occlusion [see Teaching Use of Visual and Non-Visual Techniques and, for specific information, see Examples of Strategies for Teaching Non-Visual Skills and Use of Non-Visual Information to People with Functional Vision]. These other teaching strategies aren't as easy as using blindfolds, but training with the blindfold doesn't prepare clients to use the non-visual information in real-life, realistic situations.
In the April 2007 Braille Monitor, Matthew Maurer, Edward Bell, Eric Woods and Roland Allen said that "In learning cane travel, the goal is for the student to learn techniques that are wholly non-visual in nature." Many of us believe that the goal for O&M training is much more broad -- our goal is for students to learn techniques that enable them to travel safely and effectively, be it visual, non-visual or, ideally, both. We believe that best practice for clients with functional vision means not only teaching them non-visual techniques but also teaching them the remaining three necessary concepts and skills related to sensory information:
Learn to not allow their vision to distract them from noticing and using non-visual information;
Learn how to use their vision reliably and efficiently; and
Learn how to use non-visual and visual information together.
When I first started to teach O&M, we didn't know how to teach other than by using blindfolds, and so that is how I taught my clients. But when the blindfold came off, time and time again clients reverted back to using vision -- vision which was less effective than the non-visual information, often unreliable and sometimes dangerously misleading. For example as they walked toward an unexpected stair where the ground looked flat, when the cane went over the edge (providing information that they had easily detected when using a blindfold), they kept walking because they trusted their vision and ignored the non-visual cane information.
The reason for this phenomenon might be explained by a recent Harvard Medical School study in which healthy, sighted adults were blindfolded for a week and studied braille every day (see study by Alvaro Pascual-Leone reported in Wall Street Journal). After just a few days, their visual cortex was processing touch, rather than vision.
Perhaps if clients learn non-visual skills only under blindfold, as the subjects did in this study, it is their visual cortex that is used to process that information, so when the blindfold comes off, the visual cortex returns to processing visual information, not the non-visual information it had learned to process. So the brain, unprepared and unable to process non-visual information elsewhere, ignores it, and instead uses visual information, even though it is insufficient or misleading.
Regardless of the reason, I can tell you with assurance that when people learn from the beginning to use the non-visual information under realistic circumstances -- that is, while their vision is not occluded -- they are able to notice and use it effectively and are not likely to revert back to ignoring non-visual information.
Some administrators and instructors say that all clients who have functional vision should be encouraged to immediately get all the training that would enable them to function without vision, so that they don't have to return to the program for more training if / when they lose that vision. It is certainly true that if people are unable to function visually in certain conditions, such as at night or in bright sunlight, or if their vision fluctuates such as from diabetic retinopathy, they should be given the opportunity to prepare for travel in all conditions, including total blindness. However, preparing them for visual situations that may or may not occur in the future is an ineffective use of resources because:
that kind of training usually requires a minimum of 100 hours, whereas people with functional vision often learn to travel with confidence and safety with as little as 20-30 hours of training;
people who are learning a skill that they don't need usually are not motivated, and without motivation the learning proceeds much more slowly. Numerous times I've tried to teach people how to use a skill, such as the cane or non-visual techniques, and they just didn't seem to get it. We drilled and drilled but between sessions they didn't practice it, the progress was very slow and in many cases they didn't acquire proficiency. But when some of these people came back for training several years later, when they NEEDED the skill, they seemed like different people -- they learned the skills very quickly, and our training time was short and efficient.
It is unreasonable and unrealistic to expect that people will get all the training they need for their entire lives at one time, and remember and be able to use those skills months or even years later. I've worked with many people who had previously had extensive training at a center and went home and never used it for one reason or another (such as because they used their vision, or they had preferred to travel with family and friends). When I started teaching them, I was amazed to find that it was as if they had never been trained, we had to start from scratch. This return for training is sometimes referred to as "recidivism," but that word means "repeated or habitual relapse, as into crime" or, from Stedman's Medical Dictionary: "A tendency to lapse into a previous pattern of behavior, especially a pattern of criminal habits. The relapse of a disease or symptom." This terminology gives the impression that clients are in our program for the purpose of rehabilitation to meet our standards and develop the "correct" attitude or correct values, and when they lose more vision they revert back to their criminal or unacceptable level of behavior. Losing more vision and needing more training isn't a "relapse," it is a natural process of progressive adjustment and it is easily and much more efficiently addressed with appropriate training that is provided when needed -- that is, when the training is meaningful and the person is motivated.
Best Practice: Teaching crossing at modern signalized intersections
Traditional street-crossing strategies, which we've been teaching since the 1940's, rely on predictable patterns of traffic. But modern signals are actuated and therefore unpredictable. The traditional strategies also rely on simple traffic patterns, and modern signals are complex and the traditional street-crossing strategies are no longer effective and reliable. Therefore O&M best practice requires the use of modified street-crossing strategies.
For example, actuated signals do not routinely provide pedestrians with enough time to cross unless they push a button. The signals can give as little as 5 seconds of green after a car surges forward (the traditional cue that the signal has turned green). Five seconds is not enough for the average walker to cross even two lanes. Pedestrians who cross without pushing the button face the risk of still being in the street and crossing after the signal has changed to green for the traffic on the street they are crossing.
Role of administrators:
I brought up the topic of modern traffic signals as a segway to my next topic -- the role of the administrator in O&M programs, and issuing directives that require that O&M be taught in a certain way. Several years ago, the administrator of the state agency for the blind in Pennsylvania issued a directive that O&M specialists were to teach their clients not to push pedestrian buttons. This obviously reflected a gross lack of understanding of the way that modern signals work. O&M specialists who followed that directive would be going against best practice, and their clients would receive negligent instruction that would leave them unprepared to cross streets safely, undoubtedly leading eventually to serious injuries or fatalities. Other administrators of O&M programs have issued directives or requirements for the O&M instruction, for example requiring that all instruction must be provided with blindfolds (which, as I've already explained, does not prepare clients to use non-visual information in real-life situations), or requiring that certain traditional O&M techniques not be taught to their clients.
When the administrator directs how the O&M is to be taught, the best case scenario is that the O&M instructor's hands are tied, and teaching strategies that are potentially effective or optimal are prohibited, and the worse case is that the resulting instruction is negligent or dangerous. In effective O&M programs, the administrator hires O&M specialists who:
can be trusted to provide quality O&M;
understand and share agency goals;
know the material to be taught and keep updated (O&M specialists need comprehensive personnel preparation and continuously need ample opportunities for professional development);
have high expectations and a strong belief in the abilities of blind people (comprehensive successful experiences traveling under blindfold can help, as well as knowing blind adults who are capable independent travelers; click here for a story about the high expectations in the first O&M specialists -- expectations which were developed after they had been trained);
have good teaching skills for a variety of learners, and can vary the teaching style to suit. If the instructor has only one teaching strategy, and doesn't have a variety of teaching styles and cannot modify to suit the learning style and needs of the student, there will be students who will not be able to learn from them.
With these instructors on staff, the administrator respects the O&M specialists and has no need to issue directives specifying exactly how they are to provide the O&M services or what strategies they will use, any more than an administrator would issue directives with specifics as to how the agency's occupational or physical therapists are to provide their services.
Goals of the program
When establishing goals for the O&M programs, we need to respect the client's values. Some professionals believe they know what's best for the clients because they have a degree in O&M and years of experience teaching blind people. Some professionals believe they know what's best for their clients because the professionals themselves are visually impaired or they know lots of blind people and have therefore benefited from experiences which prepare them to understand what is best for all blind people.
But what is best for our clients depends on their values, and no amount of training or experience can prepare us to determine what is best (see "Decisions, Decisions: Who Knows What's Best for Our Clients" for further discussion on this issue). Rather than fail our clients or refuse to serve them or report that during training they exhibited the wrong attitude to benefit from our programs, we need to accept and respect them and their values and help them achieve goals that are theirs, not ours.