Abstract
This research evaluated the impact of COVID-19 on orientation and mobility (O&M) services for school-aged students, families, and service providers. The survey asked O&M specialists about their instructional practices and decision-making processes regarding remote instruction service provisions, allowances, and district guidelines. The online survey collected data from October to November 2020, with open-ended responses from 166 O&M specialists. A thematic analysis was used to examine and code qualitative responses. Respondents were found to divide remote instruction into two categories, foundational skills and high-level travel skills. A preference for teaching foundational skills during remote instruction was also identified, with concerns for student safety and practitioner liability reported as the deciding factors. Field-specific guidelines and potential legal vulnerabilities regarding remote instruction are considered, with an analysis of negligence and professional liability. Practices used during COVID are also examined according to the COMS Code of Ethics and Scope of Practice. The findings demonstrate the need for field-specific guidance and research-based instructional methods regarding remote instruction. O&M specialists should continue to conduct a thorough risk assessment before utilizing new and unresearched remote instructional methods as a means of acting in the best interest of the student.
In practice, orientation and mobility (O&M) specialists are required to consider all potential risks and training situations that could put a trainee in harm’s way (Wiener et al., 2010). As the COVID-19 pandemic quickly changed our way of life, both personally and professionally, new protocols suddenly became the routes O&M professionals were asked to navigate. The unpredictable and quickly changing protocols were not only difficult to navigate but inconsistent among U.S. governing bodies including, but not limited to, the U.S. Department of Education’s (DOE) Office of Special Education and Rehabilitation Services (OSERS), Office of Civil Rights (OCR), and federal and state COVID-19 guidance documents (Krebs, 2020; U.S. DOE, 2020). State agencies, nonprofit organizations, school districts, and private entities rolled out regulations for remote instruction requiring O&M specialists to implement this still untested and unproven service deliver model.
To date, remote instruction is not a method O&M specialists rely on, receive standardized field-specific university preparation on, or have research-based guidance to work under. From its inception, O&M has always been taught in-person due to the nature of its instruction and the availability of virtual means prior to the 21st century (Wiener et al., 2010). Wiener et al. (2010) stress that safe and purposeful assessment and instruction of O&M “must occur in the environments in which the skills will be used, the natural setting” (p. 509). Currently, teaching an individual with a visual impairment to cross a street in the actual environment is considered best practice, which is especially true when real-time sound localization and traffic pattern knowledge must be understood for safe passage and accurate veer correction. Research specifically considering remote O&M instructional methods to date, are few and far between, investigating the use of virtual reality (VR), telecommunications, and videoconferencing.
Bowman and Liu (2017) noted that VR can be useful in building some basic street crossing skills; however, VR instruction cannot take the place of training in natural settings and cannot accurately address student response to driver mistake, driver unpredictability, veer correction, and other unexpected real-time events. These findings support safety guidance when increasing independent travel skills, as Jacobson (2013) notes, “the possibility that the student will make mistakes and be injured increases” (p. 339). O&M specialists know that skills learned in perfectly controlled environments do not prepare individuals for split second decisions that have to be made in uncontrolled pedestrian situations where the likelihood of localization and detection errors increases (Wiener et al., 2010).
Telecommunication was evaluated as a remote option for early intervention (EI) services, with Dewald (2019) documenting the following benefits: equal access to services, cost efficiency in service provision, and a supplemental alternative for addressing educational services for EI students and families. In terms of student outcomes, skill acquisition, and helping EI participants learn physical concepts, Dewald (2019) still recommends in-person instruction as the best practice. Videoconferencing investigated a wraparound service for students returning to their home district, from the Texas School for the Blind and Visually Impaired, as a means of skill retention and follow-up service (Rose, 2020). Videoconferencing was not a replacement for direct instruction but instead considered consultative in nature. Rose (2020) notes that additional research must be completed to determine best practices for addressing individual skill areas through videoconferencing. It should also be noted that this final study did not consider O&M and, therefore, does not provide guidance for remote instruction. Within these limited studies, certified orientation and mobility specialists (COMS) find themselves returning to their core university preparation program, professional development trainings, and field experience guidance requiring instruction in natural settings.
One could argue that the best practice consideration regarding in-person O&M is more a matter of prudence when considering the outcome of instruction, that is, independent travel. Traveling from one place to another is a physical act, an act that cannot solely be learned sitting behind a computer monitor. The federal government recognized the need for essential workers due to the physical nature of their work as pandemic regulations were put into place (Krebs, 2020). According to the Cybersecurity and Infrastructure Security Agency’s (CISA) Advisory Memorandum on Ensuring Essential Critical Infrastructure Workers Ability to Work During the COVID-19 Response, human service providers providing services to individuals with disabilities, at-risk populations, vocational services, and rehabilitation services are considered essential workers (Krebs, 2020, pp. 8–9). Unfortunately, different state- and community-level governing bodies all interpreted the CISA language differently, stopping many COMS from in-person work despite the fact that O&M falls under the CISA definition. Thankfully, state agencies for adult service providers that understood the CISA language allowed a quick return to in-person instruction.
Applying the CISA language, one Midwestern state Association for Education and Rehabilitation of the Blind and Visually Impaired (AERBVI) chapter published a white paper to establish O&M as an essential service under federal and state language (Welch-Grenier & Fast, 2020). It is important to note that this is not the first time that the essential nature of O&M assessment and instruction has been recognized federally in the United States. The first recognition was in the 1940s when the Surgeon General’s office began implementing formal O&M instruction for veterans through the Veterans Administration, with additional recognition coming through the U.S. Department of Education, Rehabilitation Services Administration, Department of Health and Human Services, and Individuals with Disabilities Education Act in 2004 (Wiener et al., 2010). This historical recognition of O&M as essential in the lives of individuals with visual impairments suddenly found itself on the chopping block of the ever-changing COVID-19 regulations. Even with federal recognition and understanding of the importance of accurate and safe in-person O&M instructional practices, remote instruction complicated this issue by asking instructors to consider working against the nature of their field. Due to this, instructors found themselves quickly calculating what could be delivered through remote means. Within these additional professional responsibilities, the following questions were considered:
What areas of instruction did O&M specialists provide during remote instruction and what factors impacted the decision-making process?
What types of remote instruction did O&M specialists use during the pandemic?
Methods
The Access and Engagement II survey collected data from October to November 2020, ending 9 months into the pandemic (Rosenblum et al., 2021). This survey was completed by 79 O&M specialists and 87 dually certified professionals (i.e., teachers of the visually impaired and O&M specialists). A Qualtrics online survey was designed by O&M specialists before distribution through professional listservs (e.g., Association for Education and Rehabilitation of the Blind and Visually Impaired O&M Division listserv), Facebook groups, and other digital O&M professional platforms. Each survey participant completed three sections within the survey to assess how the pandemic impacted instruction and interactions with students and families. All survey data were deidentified. General descriptive statistics were collected regarding credentials, caseload numbers, and teaching role. Survey participants were given the opportunity to provide responses to open-ended questions regarding how services were conducted, what types of remote instruction methods were used, the impact of pandemic regulations on instructional allowances, and concerns regarding implementation of required regulations.
The survey was available to O&M specialists working with children in the United States and Canada throughout the fall of 2020. The study was approved by the American Foundation for the Blind Institutional Review Board, with informed consent obtained before the completion of each survey. Descriptive statistics for O&M specialists could not be separated from other professionals completing the survey. The entirety of professionals completing the survey was 85% female and 81% White. The majority of O&M specialists that completed the survey were COMS (140), with the remainder of participants certified through National Orientation and Mobility Certification (1), uncertified (25), or completing O&M internships (4). Potentially many professionals were left unaware of the study since the survey was only offered through online platforms, a limitation in the audience reached.
Data analysis
A qualitative coding system was used to identify common themes among respondent statements through an inductive approach. The authors all hold COMS certification and used their professional training, certification, and knowledge to interpret survey results. Data were analyzed through an exploratory approach with four researchers independently applying a thematic analysis to compile consistent themes within each data set. Predominant codes within the data set were extrapolated for this article that focused on O&M specialists remote instruction decisions, concerns, and allowances during the pandemic. Two researchers coded open-ended responses individually and reviewed and discussed independent coding to reach a consensus on codes and themes. Two additional researchers reviewed the coding and consensus to ensure consistency throughout. Interrater reliability was met through two researchers independently coding each open-ended response and determining final themes, discussing results, and reaching 100% agreement on each coding entry.
Results
Instructional decisions were impacted by state and local governing body allowances, with some O&M specialists only allowed to conduct remote instruction, others hybrid interactions, and few in-person training with built-in social distancing and face masks. Remote instruction methods varied from tablets and computers to telephones calls and videoconferencing platforms. Hybrid lessons consisted of some in-person social distanced lessons and remote support, assessment, referral, and education. As the pandemic continued well past any governing bodies initial predictions, O&M specialists began adjusting their teaching methods according to the long-term governance changes, with many feeling overwhelmed between the health and wellbeing of themselves and their students and the safety and legality of remote instruction, in-person social distanced instruction, and efficacy of the rapidly changing instructional allowances. Instructional methods used by O&M specialists were found to split consistently into two categories of instruction, foundational skills and independent or high-level travel skills. Remote instruction methods varied by situation, instructor and family comfort level, and the availability of technology. Finally, liability, safety concerns, and ethics were reported as the main factors in the decision-making process regarding instructional skills and remote instructional methods.
Foundational skills
I am comfortable with concept development, introductory cane skills, and support through remote instruction. Feet on the street makes me very uncomfortable.—Survey Participant
The majority of respondents preferred working on foundational skills during the pandemic, regardless of the method of remote instruction being used. O&M instructors reported that foundational skills could be worked on with some success through videoconferencing with students and families. The extra time allotted for these skills during remote instruction also helped to reinforce both assistive technology use and proficiency within the areas covered. Respondents categorized foundational skills into a handful of categories, including mapping and spatial concepts, body image and awareness, functional vision and low vision aid use, environmental concepts, orientation aids, assistive technology, and other travel-related concepts. Other travel-related concepts focused on college preparation and transition-related skills, daily living tasks, traffic laws, appropriate weather attire, and utilizing research and resources for daily care needs. Finally, instructors also raised concerns that the knowledge gained may not be carried over into real-life situations once in-person instruction resumes.
High-level travel skills
I am not comfortable providing instruction on more advanced concepts via online methods, like video streaming, largely because cell networks are inconsistent and tend to lag and that’s a major safety issue.—Survey Participant
Respondents classified high-level travel skills as any form of independent travel outside of the student’s home (e.g., navigating within one’s neighborhood and community, independent street crossing, public transportation use, and small and large business district travel). Respondents handling of high-level travel skills fell into three categories, those who refused to cover high-level travel skills, those who had parents monitor previously learned techniques through a variety of remote means, and those who used social distancing techniques. As previously stated, instructors that refused to allow for high-level travel skills focused on foundational skills only and vowed to return to high-level skills when lockdowns end. Parents that refused high-level travel skills shared concerns about exposure to COVID-19, lack of time in their schedule, and discomfort with role-release without prior instruction.
Those willing to engage in outdoor travel through remote instruction used a handful of creative solutions to allow for this travel. Parents were asked to use video calling and video recording as a means of monitoring skills and providing feedback. As instruction progressed, respondents reported safety concerns regarding disconnections and delays in video calling, as well as concerns regarding injuries to parents and/or students occurring during video recording. O&M instructors that worked on social distancing methods also found some success in either maintaining more physical distance, using a walkie-talkie system, or a self-created tether. The difficulty reported with these techniques was timely intervention during high-risk travel situations due to the amount of distance between the instructor and student. Respondents recognizing this difficulty found themselves closing the gap, only to report violating social distancing guidelines (Centers for Disease Control and Prevention, 2020).
Assessments
“The virtual assessments I have done are less thorough and rely more on student self-reporting and family input and may not reflect what I see in an in-person assessment.”—Survey Participant
Respondents addressed the assessment process as a separate concern throughout the data set. Respondents reported that it was necessary to rely on video recordings, record reviews, and family and student self-reporting during remote assessments. Concern was reported by the majority of respondents regarding the accuracy of remote assessment methods due to the field-specific performance-based multisetting observational assessment requirements taught through university preparation programs and field-specific manuals. Respondents noted that the observational performance aspect of an O&M assessment is critical in determining appropriate service delivery hours, instructional goals, and trainee health and safety needs.
Discussion
Remote O&M instruction can be useful for concept development, expanding technology skills and other lower risk activities. My concerns from an ethical, litigious, and liability perspective are greater if instruction includes variables that are not always predictable such as residential, commercial, or business travel. If I am beyond arm’s length, my comfort level to put an emergent or intermediate level student in harm’s way will never be something I can accept. Even an advanced student cannot always predict with certainty an unpredictable environment.—Survey Participant
Respondents highlight several key concerns regarding remote O&M instruction that must be considered by the field before implementing unresearched remote instructional practices. First, a preference for providing foundational skills over high-level travel skills due to concerns for safety and liability are legitimate concerns because O&M specialists are tasked with ensuring student safety in all aspects of training, a task that requires adherence to instructional best practices and compliance with the Academy for Certification of Vision Rehabilitation & Education Professionals (ACVREP) COMS Code of Ethics (Wiener et al., 2010). Second, the role-release of skills should be prescriptive in nature (Wiener, et al., 2010, p. 175), not compelled through pandemic restrictions. It is important for instructors to ensure that anyone who is monitoring the student’s skills is not participating in role-release without being “adequately trained to do so” (Marsh et al., 2000, p. 506). Placing a parent in premature role-release situations can also call into question one’s adherence to the COMS Code of Ethics.
Third, increasing distance between a student and instructor should be carefully calculated and proportional to the student’s skill level to ensure adherence to best practices, safety guidelines, and the COMS Code of Ethics (Jacobson, 2013; Wiener et al., 2010). Ethically, an accurate assessment of O&M skills must be completed before any determination of instructional needs can be made. While Zebehazy et al. (2005) found that O&M instructors could assess some skills accurately through digital video recordings, this does not account for environmental and safety concerns occurring during travel. Although there are areas of self-reporting that can be used, relying solely on self-reporting and/or family reporting can be problematic due to under and overestimating skill levels, further calling into question reliance on remote assessments without research-based guidance on how to accurately complete them (Wiener et al., 2010).
COMS code of ethics
Most families do not want to work on higher level O&M skills with their children. I have had several mention to me that they ‘do not feel qualified’ to work on those O&M skills correctly and it makes them nervous.—Survey Participant
In conducting remote instruction ethically, several areas stand out. The COMS Code of Ethics (ACVREP, 2013) was written to protect the instructor, instructee, and community, the underlying intent of all professional codes of ethics. Within this code, instructors must consider the decisions and rights of the instructee and their support network through open collaboration when determining instructional goals and programming needs to ensure the COMS is acting in their best interest (ACVREP, 2013, § 1.1–1.2). In the event that caregiver hesitancy is present, as was documented throughout participant responses for high-level travel skills, asking parents to take over an early role-release instructional position before they are properly trained to do so is not supported by the COMS Code of Ethics (ACVREP, 2013). Although some parents were willing to take on the role-release responsibility, it is imperative that instructors fully inform caregivers of the risks involved in moving toward a more independent level of travel, as this is considered best practice when direct supervision shifts away from the instructor (Marsh et al., 2000, p. 502; Wiener et al., 2010, pp. 407–410). Even with informed consent, the “O&M specialist should never assume that a child [or caregiver] understands a concept, especially if understanding the concept is necessary for safety” (Marsh et al., 2000, p. 502).
When seeking guidance on how to implement remote instruction, the updated COMS Code of Ethics states: When planning or using alternative or new methods for instruction (e.g. remote instruction, role-release, group instruction) the COMS will consider the safety and the best interest of the client, impact on team members, ethical implications of the method based on ACVREP standards, consultation with relevant professionals and jurisdiction regulations. (ACVREP, 2022, § 3.7)
In following this guidance, instructors have one document to refer to, the ACVREP (2020) COMS Subject Matter Expert Committee (SME) Guidance Letter for Remote Instruction. Through this document, COMS are asked to complete a risk assessment before implementing any remote or telehealth instructional methods of their own design or the design of other O&M professionals sharing novel ideas (ACVREP, 2020). COMS are also encouraged to discontinue remote instructional methods when the risk assessment finds said methods to be too risky. The entirety of this guidance document focuses more on the adherence of ethical practices and less on how to implement remote instruction, to no fault of the SME committee because best-practice strategies have neither been researched or implemented regarding remote instruction.
Liability considerations
Implementing remote instruction without research or best-practice guidance is problematic from a liability perspective. To be liable for an injury, an individual or entity must be negligent. “Negligence is that conduct which falls below a prescribed standard established for the protection of others. This hypothetical standard is what a reasonable and prudent teacher in this situation would or should have done” (Bina, 1976, p. 226). To establish the hypothetical standard of care, professional standards, the COMS Code of Ethics, and expert opinions through a panel of professional peers would be used to evaluate the actions deemed negligent (Daggett, 2014). Daggett (2014) stresses field experts cannot support a practice not provided for in research, training, or field-specific literature. In that vein, the Association for Education and Rehabilitation of the Blind and Visually Impaired O&M Division’s approved Scope of Practice for O&M specialists does not include remote instruction as an O&M instructional technique or provide decision-making guidance regarding remote instruction (Kaiser et al., 2018). Daggett (2014) stresses courts will also consider foreseeability and causation, “if the injury was foreseeable and precaution was not taken, negligence is found” (p. 310). The nature of O&M involves placing students in potential situations and uncontrolled environments to build independent travel skills and conceptual awareness, making an unforeseeable argument almost impossible (Marsh et al., 2000, p. 496).
In the instances that parents have agreed to participate in novel remote instruction methods recommended by an O&M instructor, one could argue the parents have taken on an assumption of risk. An assumption of risk is a legal defense to liability that “requires proof that the plaintiff knowingly and willingly placed [themselves] in a situation in which the exposure to risk occurred” (Marsh et al., 2000, p. 501). This defense also proves difficult, as children cannot take on an assumption of risk due to age, and it cannot be assumed that parents, regardless of experience, fully understand the risks involved in traveling with low vision or no vision (Marsh et al., 2000); this is especially true when being asked to record students from behind, use video calling, or other remote means that can distract from one’s ability to provide the level of supervision required. All of these factors would also be considered from the perception of a jury, individuals from the general public that still find independent travel for those with visual impairments astonishing (Wiener et al., 2010, p. 407). “One must consider the misconceptions that a jury might have regarding [disabilities]. Included in this is the overprotectiveness of and sympathy for the injured [person with a visual impairment]” (Bina, 1976, p. 227).
Liability insurance
Two main professional liability insurance providers are used by O&M specialists, Health care Providers Service Organization (HPSO), and Forrest T. Jones and Company (F&T). For this writing, both companies were contacted in April 2021 to determine what O&M instruction would be covered through remote instruction. Under their telehealth provisions, all areas of O&M instruction would be covered under a liability claim according to both companies (F&T, 2021; HPSO, 2021). The Midwest district underwriter for F&T added that this included street crossings that require instructors to provide visual, auditory, and physical safety monitoring (F&T, 2021). This might make providers breathe a little easier; however, the policy language should also be considered. Section P. IV. Exclusions states: This policy does not apply to Claims for or arising out of or in any way related to: A. Activities not conducted in the scope or performance of your professional educational duties in your capacity as set forth in Item 7. of the Declarations and Section III. 0.1. as an educator and for which you have received formal, specialized training. (F&T, 2021)
As there is limited formal university preparation for remote O&M instruction, liability protection may be limited if not voided through the policy’s exclusions clause.
In addition, moving from the exclusions clause to declarations section 7, reroutes policyholders to item 2 of their attached application (F&T, 2021). Item 2 of the application is where O&M specialists must list the instructional activities to be covered by the policy. Applicants are encouraged to use additional attached pages and documentation, if need be, to ensure a thorough list is provided as a means of ensuring coverage for a given activity (F&T, 2021). The level of detail listed under item 2 by an applicant could also impact the coverage provided.
Implications for practitioners
Throughout the pandemic, O&M specialists have pulled together to try innovative and new approaches to meet the needs of students. In years to come, these new approaches may become best practices. Until this point, O&M specialists are right to differentiate instructional tasks into low-risk foundational skills and high-risk-independent travel activities. As the SME’s guidance document encourages, a thorough risk assessment is the best way to ensure that instructional decisions not only ensure the safety and best interest of a trainee but also meet the COMS Code of Ethics and Scope of Practice (ACVREP, 2020).
Practitioners should also reach out to their liability insurance companies and thoroughly read through their current insurance policy, ensuring that the full scope of O&M training is covered during remote instruction. Providing a detailed description of instructional activities, as well as wording that includes remote instruction, when applying for coverage is also essential. Finally, those areas of instruction that are deemed high risk and are not supported by best practices or research may need to be avoided altogether until in-person instruction can occur, or research-based best practices are created.
Future research
As the pandemic continues into its third year, the reality of remote O&M instruction is becoming the rule, not the exception. Future research is a necessity. Research regarding the types of O&M skills that can be successfully and safely taught through remote instruction, as well as the methods of instruction that work best need to be examined. In addition, short- and long-term outcome measures and transference of skills into everyday real-world situations should be evaluated. If students cannot transfer the skills into everyday practice, O&M specialists need to be aware that specific skills may need to be retaught during in-person travel. Research on remote supervision methods for independent outdoor travel need to be evaluated for safety and appropriateness. Establishing research-based guidance on travel skills that should not be attempted through virtual means would benefit O&M instructors in making risk assessment determinations. From an ethical and liability perspective, additional guidance is necessary.
Conclusion
As stated above, O&M specialists fall under CISA’s human services essential critical infrastructure workers language and can be added by name to the list of designated essential workers federally or within a given jurisdiction with a written request (Krebs, 2020). Although the federal list of essential workers is not exhaustive and is written to be inclusive and not exclusive in nature, the absence of O&M as an approved essential field has led to varied inconsistent policies creating the necessity for remote instruction. As the O&M field continues to grapple with remote instruction through research, collaboration, and discussion, the immediate and direct impact on students must be addressed. Establishing O&M as an essential service federally would work to provide support for the in-person nature of O&M instruction (Welch-Grenier & Fast, 2020), much like the provision of O&M in the language of the Individuals with Disabilities Education Act (2004) has worked to ensure the rights of students in receiving O&M assessments and services within the U.S. public school system (Wiener et al., 2010). The field has advocated collectively once before, and this may be the time to advocate collectively once again.
