Editor’s note: Vision Rehabilitation Therapist Appreciation Week is observed annually over Anne Sullivan’s birthday, April 14th. Are you interested in learning more about vision rehabilitation therapy (VRT) as a possible career? Visit Get Learning – AER (aerbvi.org) to read about the roles and responsibilities and Directory of University Professional Programs in the U.S. and Canada – AER (aerbvi.org) to view a list of university programs that prepare you for the career. You can also visit Academy for Certification of Vision Rehabilitation & Education Professionals – ACVREP to learn more about the certification process and view employment opportunities. The following reflection is on working environments as a VRT who is low vision.
Vision rehabilitation therapists (VRTs) work in various settings such as Veteran’s Administration hospitals, nonprofit agencies, or state agencies. Instruction can be delivered via the itinerant model (visiting clients in their homes) or center-based (offering classes at the facility). In this article, I will reflect on these two approaches from the lens of a professional who is visually impaired and has worked in both scenarios.
For me, itinerant work required a partnership with a driver. As an itinerant instructor in an 11-county service area, I worked closely with a driver my employer hired. Some of the clients I worked with lived in the middle of nowhere, miles away from other transportation options, so this support was necessary.
In addition to getting me to locations, my driver was able to assist with orientation to the instructional area in the home. For example, I would often be asked to label students’ appliances. The driver would describe the buttons and dials on the appliance so I could work effectively with the student to develop a labeling system. The driver also could describe the home environment, such as whether there were steps or railings. This was helpful because I could plan what technique to use with my dog guide when entering the home. I liked the teamwork, the one-on-one work with a student, and the stimulation of facing new situations.
Itinerant work can be difficult. It is so dependent on a driver that not having one, even temporarily, can lead to some challenges, even the need to reschedule an appointment if the location is remote. Dog guides can be an issue too. Once, I was at a student’s home with my dog guide and noticed the dog was continuously distracted by something. I couldn’t see what was happening, so I had to ask the student. There was a sandwich on the floor! I moved to another seat in the room. I didn’t have a driver for that appointment, or I would have been told about this and could have planned my seating accordingly. I’ve also encountered some families who did not want me to bring in my dog guide.
Working in a center environment is less challenging from a transportation perspective. The only requirement for the professional who is blind or low vision related to transportation is getting to and from work each day. Once the professional has arrived at the worksite, transportation is not a barrier during the workday.
Another benefit for me in the center-based instructional milieu was the ease with which I could orient to the facility. I could take my time learning where classrooms and supplies were located with the assistance of colleagues. Having confidence when traveling around the center made my work much easier than the stress of frequently working in unfamiliar homes.
At the center, I could set up the classroom in such a way so that I knew where the teaching materials were located and could be much more self-sufficient. This modeled that individuals who are blind or low vision are capable, which was a good message for students to absorb.
Neither Guarantees Predictability!
Predictability isn’t a guarantee with itinerant work. Sometimes, I would go to a student’s home not knowing what to expect that day. I would have a lesson plan based on a previous lesson, but students might request to learn a different skill than I had planned to teach. I would have to shift gears rather quickly to be an effective teacher. While this forced me to grow as a teacher and made me model adaptability, my teaching could sometimes feel less effective.
Predictability is often not a guarantee with center-based instruction either. One day, I was asked to substitute for a colleague. I was told the client was working on a cooking lesson and would provide the recipe and ingredients. The dessert that the client wanted to make was a dessert I was unfamiliar with. The dessert did not turn out how the client remembered, but we both learned important lessons. The client learned the importance of reviewing a recipe and ensuring all ingredients’ correct measurements are available. I learned as the teacher the importance of being familiar with various ways of completing skills and cooking food.
Individual vs. Group Instruction
Itinerant instruction is strictly individual instruction. This was often challenging when students were adjusting to blindness or low vision. Additionally, students often told me that they could not perform the skill I was teaching, whereas when the same skill was instructed in a center-based class, students were less reluctant to practice.
In the center, students were often instructed in groups. Group classes ranged from keyboarding to independent living. The variety was nice. This allowed them to interact with others adjusting to blindness/ low vision. In these small groups, my role was to provide instruction on the skill that was in focus for that class period, but frequently, students learned other tips from their classmates, often unrelated to what I was teaching.
Students were typically instructed using a set curriculum in center-based programs. Although each student had individual needs, working from a curriculum was helpful because it ensured that all students were taught all areas that would enable them to be self-sufficient. I had students from age 8 to 100, so the broad approach a center could offer was beneficial.
In the itinerant instructional model, I knew what I wanted to teach from one lesson to the next based on the student’s progress. However, coming to the students’ home often would derail the planned lesson because students would tell me they needed to learn another skill that may have been more urgent. For instance, I went to a student’s home to teach about the talking book player. When I walked into the home, the student asked for instruction on her TV remote control. This derailed my planned lesson, but I was able to land on my feet and instruct the student on the more urgent goal. There was always the next scheduled lesson in which the planned topic could be covered.
Another difference between center-based and itinerant instruction was the presence or absence of students’ families. In the center, students were expected to learn skills to function independently in their homes. There were no family members to swoop in and tell the student that they did not need to learn the skill. On the other hand, when I worked in students’ homes, family members often interrupted our lessons telling students they did not need to learn the skills I was instructing. This made my work as a teacher very challenging.
Center-based instruction is certainly not without drawbacks. One issue is the transferability of skills. For example, when I taught cooking classes, I had to consider that students’ kitchen setups differ from the kitchen set up at the center. It is important to teach so that the skills students learn at the center can transfer to their lives, in this case, to their home kitchen. For instance, if the center’s kitchen has marks on the oven at 350 and 400, it would be confusing if their own oven is not marked similarly. There was always the risk of contradictions like that.
Itinerant instruction in the student’s home eliminates the issue of skill transferability. For example, if the student is being instructed on how to cook a given dish, the student’s kitchen is set up in the way that is familiar to them. Students can then transfer the skills taught during this lesson to a future cooking activity when the vision rehabilitation therapist is absent. In the student’s home, students have a say as to how their appliances are marked instead of instruction at the center where appliances are marked the same for all instructional activities.
Providing vision rehabilitation therapy in students’ homes and at centers both have rewards and challenges for the teacher who is blind or low vision. I personally prefer center-based instruction, although both approaches can work. In both environments, being flexible and adaptable are important characteristics of an effective vision rehabilitation therapist.