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at the Institute for the Blind and Partially Sighted, Hellerup, Denmark
April 26-28, 2001
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After lunch, several issues were discussed concerning methods used in the training of new instructors. The issues are only summarise briefly, i.e. many contributions have been left out, and the discussion does not always reach a conclusion, rather there is an exchange of concerns and possible solutions.
James mentioned as a problem in the UK that counties tend to keep the children in the county for local services, because specialised services are too costly. Bill said that in Holland the system was such that the funds follow the person, and the person him/herself (or the parents) buys the appropriate service. Nina questioned whether the clients were educated enough to make a good choice?
Pam and Lenka brought up the problem of over-using terminology in the talks with the client. This creates a distance and alienation, and it is an important awareness to foster in the students. J�rgen: It is also important to avoid treating the client as a subordinate 'pupil'. Bill recommended a problem-oriented approach. It is not a matter of finding out what courses the client needs, but to look at the existing problems and identifying solutions in cooperation with the client. Inge: The Danish Association for the Blind offers very good introductory courses, where recently blinded adults meet others in the same circumstances. This helps prepare the person to want and ask for additional courses (acceptance, coping). Jette mentioned a similar effect in courses at the Refsnaes School for children - when the parents visit the school for the courses, they see that other kids are able to eat on their own, etc. Pam: - Some people, however, do not like being taught in groups, because they feel that they are being compared to others, not doing as well etc. Inge: A good mix is when you meet others in the group, and then the actual instruction can be one on one.
This is an individual issue. For some, it is very important, for others, it matters less. Inge mentioned the approach of asking the client to describe how they feel they are doing and then, on the basis of this, determining 5 areas that they would like to focus on in their course. This enabling approach is described in the book "Enabling Occupation: An occupational therapy perspective" (more information on page 44).
Pam: What requirements can the programmes make on the students - can you, for example refuse the certificate to someone because they are unable to teach, have claustrophobia or other conditions that make them unable to meet the actual requirements of the job? Lenka pointed to the Czech verification exams, which have been set up to safeguard the quality. If you fail twice, you have to stop teaching. Everybody agreed that it was desirable to stop unfit students as early as possible - also for the student's own sake. Pam said that this was one reason why the students in the IRIS programme are asked to teach (handwriting) at an early stage, so that it is possible to spot the ones who just cannot teach. The course has a probationary period of 17 weeks. Bill said that at Het Loo Erf, you have to accept everyone, because the applicants are already employed and active in the field. In Switzerland and Holland, the employers decide over the place of education, in Germany, the education provider is independent. Inge asked how absenteeism should be calculated - % of a given subject or % of the course overall?
A good teaching aid - and a good technique to introduce to the student, so that they learn to use it themselves. James mentioned that at the GDBA, the training kitchen has permanently mounted cameras (this made everyone very jealous). The video is good for simulation and for teaching skills/teach back (where the student teaches what he/she has just been taught). Focus on verbalisation, relationship, organisation etc. One the issue of whether it was OK to save the tapes and show them to later students, opinions were divided - some thought no, others thought it was OK if a permission was obtained. Jette mentioned a video on ADL that was used to show the parents, so that they could see that it was possible, and it was not terribly difficult.
Bill: It is essential that the instructor knows and understands the actual diagnosis. Brain damage means many different things and has many different effects - and it has a very broad effect on O&M (especially in terms of spatial understanding) and ADL. Here, you cannot get by with just general knowledge, you need specialisation - important that the instructor acknowledges his/her limitations. The education should include an introduction to the area, so that they recognise it when they come across it. Jette: When working with children, we always have a multidisciplinary approach in order to discover the child's learning style, strong sides etc. This multidisciplinary approach is generally good - and with clients with brain damage, it is essential.
Pam: IRIS uses goggles (partial occlusion) first, then blindfolds (complete occlusion). Otherwise, the students may resort to blindfold techniques when the partial sight situation becomes too difficult (e.g. tunnel vision). IRIS uses welding goggles. James: the GDBA courses use goggles from Canada, but they are not that comfortable to wear. J�rgen: At Blista, we make our own then test them and mark them with acuity. Nina: We make our own, based on welding goggles with replaceable lenses. J�rgen: At Blista, the students also go from the easier to the harder lenses in order to avoid that the students switch to complete blindness techniques when it gets too difficult. This also provides an awareness of when it may be easier to switch. Lenka: Blindfolds make the students lose a sense of time; part of the purpose is to give the students the experience of being blind. J�rgen questioned why it had to be the first day. Lenka said that they wanted to simulate the experience that a newly blinded person may have after an accident. Inge said that in some courses, they had let the students meet each other when they were blindfolded. At the end of the day, they made dinner and set the table, still with blindfolds. Jette agreed that the time factor is important - after 23 hours, the experience is qualitatively different. Inge recommends that the students keep a journal of their experiences and emotions. At the end of course, you might otherwise forget how difficult it was at first.
Nina said that the course in Poland uses a simulated client who gets 1 page of information. The student gets slightly less information and has to find out about the client's situation and develop a list of tasks from which the client chooses the most important. Afterwards the interaction is evaluated. Doing it this way is more convenient than using a real client. Pam added that it would also make the ethics easier to handle; otherwise one has to consider when to step in, here, you can let it run further. J�rgen said that at Blista they use supervision/observation all the time anyway, the situation is not very different whether it is an exam or not.
James said they may sometimes have the students teach other students, for example the students that are one module behind. Inge said they often get calls from nursing homes or hospitals who ask for help in training their own staff the basics. This may be used as a student assignment followed by an in-group evaluation.