Orientation and Mobility Assessments for Children and Youths With Visual Impairments: How,Why,When,and Where?

Abstract

Introduction: This study analyzed survey responses from 114 orientation and mobility (O&M) specialists regarding the content and procedures they used in completing O&M assessments. Methods: O&M specialists completed an online survey in 2020 on their assessment practices for children and youths who are visually impaired. Results: Over 85% of participants identified that they interview the student, parent, classroom teacher, and teacher of students with visual impairments as part of the assessment. The only visual skills addressed by at least 80% of participants were depth perception, distance acuity, scanning, and peripheral visual fields. Students without additional disabilities in kindergarten through 12th grade were more likely to be taught the two-point touch cane technique when compared to students with additional disabilities, who were more likely to be taught constant contact. Discussion: Participants identified that O&M assessments for students in 9th–12th grade were more likely to focus on skills that would be needed for employment or post-secondary education or both, such as the use of public transportation. For students with additional disabilities or children under the age of five years, participants were more likely to conduct assessments focused on safety and immediate needs and environments. Implications for Practitioners: Appropriate O&M assessments need to be conducted in natural environments that provide equal challenges to the environments where students need to travel. O&M specialists must adapt the assessment content and procedures to address the current and future travel needs of all students with visual impairments.

Keywords

orientation and mobility O&M assessment visual impairment

The Individuals with Disabilities Education Act (IDEA) mandates that orientation and mobility (O&M) services be provided to prepare children with visual impairments (i.e., those who are blind or have low vision) to travel independently in school, home, and community environments (IDEA, 2004). O&M assessments are conducted by professionals to determine eligibility, instructional goals, and appropriate accommodations for students with visual impairments. The content of these comprehensive assessments may include functional low vision and environmental assessment data (Kaiser et al., 2018). The reason for the assessment will guide the timeline and how the assessment is completed (Bina et al., 2010). Nevertheless, an O&M assessment should adequately address both orientation skills and demonstrated performance of mobility skills, since initial assessment results and ongoing assessments are used to plan lessons, identify safety concerns, and determine the need for additional tools and technology.

Teachers of students with visual impairments identified that they sometimes needed to adapt components of their functional vision assessments depending on the individual needs of a student (Kaiser & Herzberg, 2017). Although O&M assessments are different from functional vision assessments, the diverse needs of the student population suggest that a similar individualized approach may be necessary. In particular, students with visual impairments and additional disabilities require assessments and instruction to be individualized, since their needs often diverge from traditional O&M goals and typical progression of skills due to challenges faced in natural environments (Trief et al., 2007). Since many O&M specialists are the only professionals in a school district with this specialized training,

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they may be required to create an appropriate assessment plan for each student without much assistance. Assessment tools, such as Teaching Age-Appropriate Purposeful Skills (Pogrund et al., 2012), provide a standard progression to guide professionals through planning assessments. In addition, the O&M Career, College, and Community Readiness Standards may be incorporated with the assessment tools professionals already use to determine instructional needs based on the gap between current performance and curriculum goals (Tellefson et al., 2019). Although these resources and similar tools are used by many professionals, there are still numerous decisions within the assessment process that allows for customization and adaptability as well as inconsistency across service providers.

There is a lack of consensus on how O&M assessments should be conducted and what content should be included (Robinett, 2018; Wall Emerson & Corn, 2006). Professionals in the 2006 Delphi study by Wall Emerson and Corn recommended an assessment be considered for students with a visual acuity of 20/200 or less, students experiencing a decrease in visual fields, students transitioning to a new placement or home environment, students exhibiting behaviors associated with safety or travel issues, and in preparation for an upcoming Individualized Education Program (IEP) meeting. These considerations along with factors, such as difficulty with transitions between light and dark environments, are used by professionals throughout the United States to determine the need for an O&M assessment.

Severity rating scales are used by professionals to determine and support recommendations for an appropriate amount of services based on assessment results. The Michigan O&M Severity Rating Scale and the O&M Severity Rating Scale Plus were both frequently used by professionals and found to be valid measures for O&M service requirements (Wall Emerson & Anderson, 2014). Munro et al. (2018) also established that the O&M Visual Impairment Scale of Service Intensity of Texas (VISSIT) was a valid and reliable tool to determine time and service recommendations.

There is no federal requirement for every student with a visual impairment to receive an O&M assessment, but a few U.S. states have developed their own requirements. In Texas, it is now a state law that every student who is evaluated for vision services should also receive an O&M assessment in a variety of lighting and unfamiliar conditions as well as in school, home, and community environments (Education for Children with Visual Impairments, TX. 30.002. C-1 (2)(F), 2015). In Michigan, an O&M assessment is required for every child with a visual acuity of 20/200 or less with the best correction, or a visual field restricted to 20° or less (Michigan Administrative Rules for Special Education, R 340.1708, 2013). In Maryland, students who are blind or have low vision must be evaluated by a certified or university-prepared O&M professional with input from the parents and classroom teacher. The evaluation must consider the student's age, current and future needs, and how the student functions in familiar and unfamiliar environments in various conditions (Maryland State Board of Education, Code of Regulations 13a.05.01.08, 2021).

The current study reports the results of an electronic survey administered to O&M specialists that gathered information about content, procedures, and tools that they use when completing O&M assessments with children and youths. The following research questions were explored:

What are the characteristics, background, and education of O&M specialists who complete O&M assessments with children and youths?

What procedures and tools are used by O&M specialists when completing assessments with various student populations?

What mobility devices, techniques, and specific environments are included during the assessment process depending on the age and characteristics of the student being assessed?

What content and other relevant information is included by O&M specialists in assessment reports?

Methods

Instrument

An online survey was developed using Qualtrics, a web-based survey tool. Participants were first asked to provide their consent to participate and to confirm that they met the requirements to participate in the study. Participants then answered a series of demographic questions about themselves, their caseloads, and the assessments that they conduct. Afterward, they answered questions about the procedures and tools they use when conducting O&M assessments as well as the environments and skills that they include in the assessments. Participants were asked to differentiate their assessment information depending on the student population. These populations were defined as children under the age of five, students in kindergarten through 8th grade, students in 9th through 12th grade, and students with additional disabilities that affect their orientation or mobility or both. Last, they answered a series of questions about the content that they include in the assessment report.

After initially drafting the survey questions, we asked two experienced O&M specialists to review the instrument and provide input about the clarity of the questions and the completeness of the survey. This information was used to revise the survey.

Criteria for Participation and Recruitment

Approval to conduct the research was obtained from the Institutional Review Board at the University of Kentucky and the University of South Carolina Upstate. The study was open to O&M specialists who were certified and who had completed O&M assessments as part of their professional role within the last three years. Recruitment began by sending an email and advertisement flyer to the Association for Education and Rehabilitation of the Blind and Visually Impaired (AER) electronic discussion groups for O&M professionals and faculty members associated with personnel preparation programs. Information about the survey was also posted to various Facebook groups, state listservs, and the Paths to Technology website. A follow-up reminder about the survey was sent during the first week of May and then again in September.

Results

A total of 114 O&M specialists completed the survey between April 1, 2020, and November 11, 2020. This number does not include individuals who began but did not complete the survey as their data were not analyzed. Of the 112 participants who reported their country of residence, 108 participants were from the United States, and 1 participant was from each of the following countries: Albania, Afghanistan, Australia, and Liberia. One hundred twelve participants were certified through Academy for Certification of Vision Rehabilitation and Education Professionals, and two were certified through the National Blindness Professional Certification Board. Sixty-four participants reported that they were also certified as a teacher of students with visual impairments. See Table 1 for demographic information about the participants.

Table 1.

Demographic Data of the Participants (N = 114).

Variable	n (%)
Gender
Female	95 (83.3)
Male	19 (16.7)
Years of experience
1–5	22 (19.3)
6–10	19 (16.7)
11–15	18 (15.8)
16+	55 (48.2)
Ethnicity
Caucasian	100 (87.7)
African American	4 (3.5)
Hispanic	1 (.9)
Asian	2 (1.8)
Two or more ethnic groups	4 (3.5)
Prefer to self-describe	3 (2.6)
Setting in which employed
Itinerant	86 (75.4)
Residential or specialized school	20 (17.5)
Center-based program	3 (2.6)
Early intervention	3 (2.6)
Other	2 (1.8)
Employment status
Independent contractor	13 (11.4)
Full-time	85 (74.6)
Part-time	9 (7.9)
Other	7 (6.1)

The next series of questions asked about perceptions of their initial O&M education, how many O&M assessments they completed in a typical year, and the length of time it usually takes to conduct an assessment. Almost all participants (n = 111) reported that they received some instruction during their initial coursework on how to conduct O&M assessments and determine the need for O&M services for students with visual impairments with no additional disabilities that affect their orientation or mobility or both (see Table 2 for additional information). The number of assessments typically completed each year by participants varied: 36% (n = 41) complete 1–4 assessments, 33% (n = 38) complete 5–8 assessments, and 31% (n = 35) complete 9 or more assessments.

Table 2.

Percentage of Responses to Perceived Level of Preparedness for O&M Assessments (N = 114).

Item	Students in K-12th grade	Students with additional disabilities that affect their orientation and/or mobility	Students with deafblindness	Children under the age of 5 years
It provided me with all the information that I needed to do my job.	28.9	15.8	10.5	12.3
There were some gaps in my training.	54.4	44.7	27.2	39.5
There were many gaps in my training.	14.0	34.2	40.4	35.1
I did not receive any training.	2.6	5.3	21.9	13.2

The amount of time typically spent conducting an assessment varied for the participants (see Table 3). Fifteen participants reported that they were required to use a specific O&M assessment data collection tool. The other participants (n = 99; 86.8%) had the flexibility to choose which data collection tool they used during the assessment process. Commonly utilized tools included: Teaching Age-Appropriate Purposeful Skills (TAPS), by Pogrund et al. (2012; n = 90; 82.6%); Oregon Project, by Anderson et al. (2007; n = 66; 60.6%); Preschool O&M Screening, by Dodson-Burke and Hill (1989; n = 48; 44.0%); Developmentally Appropriate O&M, by Anthony et al. (2004; n = 43; 39.4%); Hill Performance Test of Selected Positional Concepts (1981; n = 41; 37.6%); New Mexico School for the Blind and Visually Impaired O&M Inventory (2016; n = 30; 27.5%); and Texas 2 STEPS Evaluation, by Brown et al. (2019; n = 28; 25.7%). Participants were invited to write in additional tools that were not listed as choices, and some examples of these responses were the New Mexico School for the Blind and Visually Impaired Birth to Six O&M Inventory (2019) and the Framework for Independent Travel, by Briggs and Columbia (1999). Ninety-four participants (82.5%) also shared that they have adapted or created O&M data collection tools to suit the individual needs of a student.

Table 3.

Percentage of Responses to How Long it Typically Takes to Conduct an Assessment.

Item	Students in K-8th grade (n = 114)	Students in 9–12th grade (n = 113)	Students with additional disabilities that affect their orientation and/or mobility (n = 112)	Children under the age of 5 years (n = 113)
Less than 1 h	2.6	0.9	8.0	13.3
1–2 h	50.0	33.6	48.2	56.6
3–4 h	38.6	45.1	31.3	26.5
5 or more hours	8.8	20.4	12.5	3.5

The vast majority of participants reported that they typically interview the student (n = 111; 97.4%), parent (n = 110; 96.5%), classroom teacher (n = 107; 93.9%), teacher of students with visual impairments (n = 98; 86.0%), and paraprofessional (n = 94; 82.5%). Other individuals interviewed included the physical therapist (n = 87; 76.3%), physical education teacher (n = 71; 62.3%), and occupational therapist (n = 69; 60.5%). Participants also provided information about the school environments typically addressed during the assessment process. Not surprisingly, almost all participants included stairs (n = 108; 95.6%), hallways (n = 108; 94.7%), classrooms (n = 108; 94.7%), sidewalks (n = 105; 92.1%), and playgrounds or recess areas (n = 104; 91.2%). Visual skills commonly addressed in the assessment process included depth perception (n = 106; 93%), distance visual acuity (n = 99; 86.8%), scanning (n = 95; 83.3%), and peripheral visual fields (n = 94; 82.5%).

More than 75% of participants reported that they address auditory skills, human guidance, and protective techniques, as well as constant contact and diagonal cane techniques as part of the assessment process for all student groups. Participants were more likely to address the two-point touch technique for students in grades K-12 than students under the age of five years or students with additional disabilities that affect their orientation or mobility or both (see Tables 4 and 5 for additional information). Participants were also asked about the conditions and off-campus environments included as part of the assessment process. Approximately 95% of participants indicated that they include residential environments as part of the assessment process for students in grades K-12 without additional disabilities that affect their orientation or mobility or both. In addition, 91.7% of participants (n = 100) reported that they include business environments when assessing students in grades 9–12. More information about conditions and off-campus environments is included in Table 6.

Table 4.

Basic Skills and Techniques Addressed in the Assessment Process (percentages).

Item	Students in K-8th grade (n = 112)	Students in 9–12th grade (n = 111)	Students with additional disabilities that affect their orientation and/or mobility (n = 109)	Children under the age of 5 years (n = 110)
Auditory	96.4	96.4	92.7	94.5
Human guide	90.2	80.2	90.8	79.1
Trailing	86.6	65.8	86.2	84.5
Protective techniques	89.3	75.7	82.6	80.0
Body awareness	93.8	62.2	90.8	97.3
Positional concepts	96.4	70.3	88.1	87.3
Cardinal directions	92.9	93.7	46.8	12.7
Posture	88.4	77.5	82.6	84.5
Balance	80.4	73.9	82.6	83.6
Gait	85.7	77.5	89.0	88.2

Table 5.

Cane Techniques Addressed in the Assessment Process (percentages).

Technique	Students in K-8th grade (n = 112)	Students in 9–12th grade (n = 111)	Students with additional disabilities that affect their orientation and/or mobility (n = 106)	Children under the age of 5 years (n = 103)
Diagonal technique	92.0	76.5	85.8	76.7
Constant contact	96.4	90.1	87.7	84.5
Two-point touch	86.6	92.8	50.9	20.4
Touch and drag	80.4	82.9	49.1	22.3
Stair travel with a cane	98.2	95.5	83.0	68.9

Table 6.

Off-campus Environments and Conditions (percentages).

Environment or condition	Students in K-8th grade (n = 109)	Students in 9–12th grade (n = 109)	Students with additional disabilities that affect their orientation and/or mobility (n = 95)	Children under the age of 5 years (n = 83)
Home environment	54	43.1	52.6	91.6
Residential	94.5	95.4	77.9	43.4
Business	62.4	91.7	54.7	9.6
Public transportation	45.9	88.1	51.6	3.6
Ridesharing	12.8	71.6	31.6	1.2
Rural travel	50.5	67.0	40.0	21.7
Night travel	43.1	70.6	40.0	15.7

Participants also reported what kinds of street crossings they include in the assessment process. Of the 109 participants who responded to the question about their K-8 students, 104 (95.4%) reported they include stop sign-controlled intersections, 96 (88.1%) light-controlled intersections, 88 (80.7%) accessible pedestrian signals, and 77 (70.6%) crossings without traffic controls. Of the 109 participants who responded to the question about their 9–12th-grade students, 103 (94.5%) reported they include stop sign-controlled intersections, 106 (97.2%) light-controlled intersections, 98 (89.9%) accessible pedestrian signals, and 96 (88.1%) crossings without traffic controls. Of the 95 participants who responded to the question about their students with additional disabilities that affect their orientation or mobility or both, 68 (71.6%) reported that they include stop sign-controlled intersections, 62 (65.3%) light-controlled intersections, 61 (64.2%) accessible pedestrian signals, and 46 (48.4%) crossings without traffic controls. Less than 20% of participants reported that they include any type of intersection content with their students under the age of five years.

Participants were also asked which technology tools and/or mobility devices they include as part of the assessment process as appropriate. One hundred ten participants answered this question, and the tools most commonly addressed were monoculars (n = 97; 88.2%), adaptive mobility devices (n = 81; 73.6%), tactile or low vision maps (n = 79; 71.8%), sun filters (n = 73; 66.4%), smartphone apps (n = 72; 65.5%), and global positioning system devices (n = 62; 56.4%). Of the 113 participants who answered the question, 85 reported that they use a severity rating scale as part of the assessment process. Commonly used severity rating tools included: Michigan O&M Severity Rating Scale (n = 71; Michigan Department of Education-Low Incidence Outreach, 2017), Michigan O&M Severity Rating Scale Plus (n = 52; Michigan Department of Education-Low Incidence Outreach, 2018), O&M Visual Impairment Scale of Service Intensity of Texas (n = 37; Pogrund et al., 2017).

Slightly more than half of the participants (n = 59) reported that they spend 1–2 h writing an O&M report. In addition, 41 participants (36%) reported that they spend 3–4 h, and 9 participants (7.9%) reported that they spend 5 or more hours. Only five participants (4.4%) reported that they spend less than 1 h writing a report. More than 90% of participants reported that they include the following background information on their reports: date of assessment (n = 111), eye condition (n = 109), light sensitivity (n = 108), location of assessment (n = 105), wears glasses (n = 105), student grade or placement information (n = 105), and ocular history (n = 103). Participants were also asked about what recommendations they included in their reports. More than 75% of participants reported that they include a recommendation regarding eligibility for services (n = 100), mobility devices (n = 100), and independent travel environments (n = 89).

Discussion

O&M assessments often vary considerably in their content and focus. It should be noted that nothing in this research is conclusive on what should be included as part of any student's O&M assessment. Instead, these data should be used as a guide by professionals when planning and conducting assessments. Consistent with Wall Emerson and Corn (2006), professionals in this study identified that students should be assessed on their understanding of the world around them and their efficiency in using other sensory information to make informed decisions. Additionally, student characteristics such as age and multiple disabilities impacted whether a professional included certain skills or environments as part of an O&M assessment. Although there were similarities in what would be included in an O&M assessment across the student groups, there were also significant differences among them.

There was agreement among most participants about key elements to include in O&M assessments for students in grades K-8 without additional disabilities. We found this finding encouraging because basic skills and cane techniques are essential for safe and efficient travel. Although nearly all assessments for K-8 students were conducted at school, over 80% of professionals identified that they also assess these students in residential environments. Young students benefit from learning how to navigate natural environments outside of school that is similar to where they live. This may encourage independence and allow students to develop skills that their sighted peers are developing without specialized instruction.

Students with visual impairments in 9th through 12th grade without additional disabilities have different and complex needs, which should be reflected in the assessment process. Assessments tended to be longer, with 65% of participants reporting that they spend 3 or more hours assessing high school students. Professionals were less likely to cover basic skills such as trailing and body awareness, presumably since many teenagers have already developed these skills. Participants reported that they were more likely to assess these students’ off-campus, including traveling in residential and business environments and using public transportation systems. Learning to navigate in varied and complex environments should assist students in successfully transitioning to adulthood, including post-secondary education and employment.

Students with additional disabilities that affect their orientation or mobility or both are more likely to have a diverse range of needs, and participants reported that assessment content varied according to the individualized needs of the student. Slightly more than half of participants reported that they spend 2 h or less assessing students with additional disabilities. It is hypothesized that student characteristics such as stamina, overall health, and level of independence may impact the length of the assessment. Basic skills and cane techniques were more likely to be included within the assessment process. However, there was less agreement about assessing cardinal directions, advanced cane techniques, and complex environments.

Assessments for children and youth under the age of five years seemed more focused on gross motor skills, concept development, and sensory awareness. Similar to Hallak and Aguerrevere (2016), the majority (70%) of participants identified that these assessments typically take two hours or less to complete. Young children were more likely to be assessed in familiar environments, and not surprisingly, participants focused on safety and easier cane techniques, such as constant contact. Some participants reported that they also assess young children in residential and/or rural environments when it was appropriate for the student. Children and youths under the age of five years must develop foundational skills so that they are prepared for travel beyond their immediate home environment. As these children enter school, they should have the foundational O&M skills to travel appropriately in their school and community comparable to their peers without disabilities.

Limitations

This survey was distributed at the beginning of the initial wave of the COVID-19 pandemic in the United States, which likely affected participation in the survey, as well as how participants responded. It was also difficult to provide a comprehensive list of all content and procedures, but participants were able to write in what they do use in their assessments as well. One of the more significant (and embarrassing) oversights was that the questions related to mobility tools and devices did not list the long cane as an option, since it was assumed that this tool did not need to be identified because it is so widely used. In hindsight, if a student uses a long cane seems like important information, especially for the different student groups. State and district policies are also likely to affect assessment decisions and content, which may have also affected how participants responded. While participants were asked to identify assessment content for four groups of students, it was still challenging to accurately categorize the diversity of the student population by age and ability. Students with multiple disabilities were categorized together even though this population is diverse. For example, a physical disability may have a different impact on a student's O&M skills than a cognitive disability or a hearing loss.

Future Research

The research that is currently available regarding O&M assessments is still incomplete in many areas. Researchers should establish reliability and validity by examining how individual professionals collect, report, and share their O&M assessment data. O&M professionals also need to develop more consistent practices across the United States to ensure that the same skills and need for services are being measured. University programs should establish best practices about how O&M assessments are covered and what guidelines are provided. Future research should explore, in more detail, how the content and practices may vary for children under the age of five years and students with additional disabilities. A case study or single-subject design could provide useful information on O&M assessment practices used for specific subgroups, such as students with cortical or cerebral visual impairment or deafblindness. Individuals who are dually certified as teachers of students with visual impairments and O&M specialists may approach assessments differently based on their experience conducting functional vision assessments, knowledge of the expanded core curriculum, and the time available with students, which should also be explored in future research.

Implications for Practice

Comprehensive assessments require a student to be assessed in the school, home, and natural community environments in which they will be traveling. To collect accurate assessment information regarding the student's mobility, O&M specialists must be able to assess the students on the school campus and in various off-campus environments. Furthermore, as qualifications and experiences of the professional may affect what is included in an assessment, there needs to be a federal definition of the minimal qualifications for individuals conducting O&M assessments to include professional certification as an O&M specialist. The dire shortage of O&M services in the United States cannot be addressed until there is certainty that children and youths receive the services they need, while O&M professionals also have manageable caseloads.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Justin T. Kaiser

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