Asking New Questions to Create Effective Rehabilitation and Literacy Intervention Programs for Adults with Visual Impairments: A Sociocultural Perspective
University of Wisconsin-Oshkosh
Wisconsin State Bureau for the Blind
The steadily growing population of adults who are visually impaired presents new challenges for those whose task it is to provide appropriate services. Often, rehabilitation programs for blind and visually impaired people are the first recourse for those seeking assistance with vocational retraining. However, when blindness rehabilitation agencies discover coexisting low levels of literacy, vocational options are limited. Although rehabilitation professionals are highly qualified to address issues related to blindness and visual impairment, such as orientation and mobility, communication, and activities of daily living, they may be at a loss to address the barriers presented by limited reading and writing proficiency. Similarly, adult literacy experts are ill-equipped to assess and address the literacy needs of adults who are partially sighted. Thus, coexisting problems of low literacy levels and visual impairment hinder the efforts of both rehabilitation service providers and adult literacy educators.
Corn and Koenig (1996) define visual impairment as "any degree of vision loss that affects an individual's ability to perform the tasks of daily life, caused by a vision system that is not working properly or not formed correctly" (p. 446). Visual disability is defined as "a visual impairment that causes a real or perceived disadvantage in performing certain tasks" (p. 446). An aging population, soaring rates of adult onset diabetes, and other factors contributing to vision loss will result in a comparable increase in the need for coordinated services. Recent partnerships between adult literacy educators and blindness rehabilitation specialists, such as those established by the Bridging the Gap initiative of the American Foundation for the Blind, offer exciting possibilities for developing creative programs. Preliminary efforts have resulted in a number of novel approaches to intervention (Pestor, 2002; Wassenaar & Harris, 2002). These efforts are laudable. However, their effectiveness depends on accurate assessment of the needs of the individuals seeking services. Understanding problems caused by the interplay between low vision and low literacy requires assessment that captures and examines the social and cultural contexts of an individual's life. The new survey questions presented in this paper reflect a sociocultural perspective, consistent with the complex, integrated goals of both vocational rehabilitation and literacy intervention.
Traditional Assessment in Literacy and Low Vision
Historically, literacy assessment has focused on providing fixed-level task performance scores. Norm-referenced tests, such as the Woodcock-Johnson Psychoeducational Battery-Revised (WJ-III), are often administered, in part, because they yield both pregrade- and postgrade-level data. An Informal Reading Inventory is also commonly used to obtain global grade level scores and provide an opportunity to examine the types and frequency of reading errors. Similarly, assessment and screening in the area of rehabilitation for visually impaired adults often focuses on task-oriented elements. These include levels of functional vision, elements of orientation and mobility, kinds of tasks the individual can perform, training and assistive/adaptive devices needed, and modifications necessary for completing job and daily living tasks.
Recently, instruments such as the Checklist for Documenting Observations (Koenig, Holbrook, Corn, DePriest, Erin, & Presley, 2000) adapted from Career Counseling for People with Disabilities (Wolffe, 1997; 2000) and Wolffe's (in process) newly developed Transition Competencies Checklist offer an even broader assessment picture. These instruments go beyond a focus on specific task completion to address more situated and affective aspects, such as attitude toward work, attention to detail, willingness to follow rules, tenacity in problem solving, and ability to interact with coworkers. Although much of the focus of these assessments has been on assessing and preparing blind and visually impaired high school students for employment (Wolffe, 2002), they are either entirely appropriate or easily adapted for adults with recent onset of visual impairments. They provide both necessary and valuable information and have much to offer literacy educators and rehabilitation professionals.
We recognize that it is inappropriate to expect professionals in either field to administer highly specialized instruments that are outside of their areas of expertise. After all, literacy educators have had years of specialized training in administering normed reading tests. Rehabilitation specialists have had similar levels of professional training and experience in administering their assessments. However, we strongly advocate that adult literacy educators become familiar in the global interpretation of information obtained from blindness rehabilitation screening devices and that rehabilitation specialists learn to interpret the meanings of literacy assessments. Traditional instruments and the checklists above provide only part of the picture. We believe additional information related to social and cultural aspects is necessary to plan and implement literacy and rehabilitation programs that are effective and personally meaningful. This notion is consistent with the philosophical direction reflected in Wolffe's (2002) vocational assessment for adolescents. To understand the reasons for the questions we included in our survey, it is necessary to examine the constructs that have refined our definitions of literacy and rehabilitation and our approaches to them.
Extending the Assessment Model
The screening/assessment model we advocate not only reflects the sociocultural perspective adopted by many literacy educators, but also incorporates and applies it to visual impairment. The result is a hybrid screening instrument that addresses aspects of both visual impairment and limited literacy proficiency in contextually meaningful ways. By this we mean that relative to literacy, a sociocultural perspective examines the ways in which reading, writing, and language are defined, valued, and used within the culture and community context of the individual. When applied to visual impairment, a sociocultural perspective includes the social, psychological, and cultural aspects associated with low vision (Milian & Erin, 2001). In other words, it addresses the many contexts of the individual. Based on the pioneering notions of early constructivists, such as Vygotsky (1978), Rosenblatt (1978), and Freire (1970), a sociocultural perspective recognizes that a person uses literacy and adapts to visual impairment in unique, contextually dynamic ways.
Our new questions are based on the following beliefs and constructs:
- Reading is a constructivist process (Vygotsky, 1978). Readers do not get meaning from a text. Rather, they create or construct a unique meaning through the dynamic interaction among their prior knowledge and experience, the information suggested in the text, and the context of the literacy event (Rosenblatt, 1978).
- We use our knowledge and beliefs to read the word and read the world (Freire, 1970). The definition of text has expanded to cover all of the verbal and nonverbal signs and symbol systems encountered by an individual. Thus, the definition of literacy has expanded as well. It includes an individual's ability to construct meaning from printed materials, signs, and computer messages as well as nontraditional "texts," such as music, gestures, religious symbols, rites, uniforms, and anything else we use to communicate or make sense of our world. In the complex world of life and work in the twenty-first century, a person has to master not just literacy, but multiple "literacies" (Moje, Young, Readence, & Moore, 2000).
- A person's knowledge and identity are socially constructed (Vygotsky, 1978). They determine both how we act and react within our world (Street, 1996). Thus, the world changes us, and we change the world. How people react to us, whether they think we are smart or helpless or funny actually shapes how we act, which in turn further reinforces how they perceive and react to us. Research demonstrates that an adult with limited reading ability almost invariably had a number of negative identity shaping experiences throughout childhood and adolescence (Shearer, Ruddell, & Vogt, 2001; Vogt, 1997).
- Researchers in the field of blindness and rehabilitation have recently recognized that many social, psychological, and physiological factors determine how individuals make sense of their vision loss, as well as the behaviors and actions they are likely to adopt (Kelly, 1995; Milian & Erin 2001). These factors are also part of an individual's socially constructed identity. Aspects of culture and community, such as ethnicity, gender, religion, economics, family attitudes, social support systems, and expectations of self and others, have a powerful shaping influence on the individual who is visually impaired.
- Fixed culture (such as race or ethnicity) plays an important role in how we define, use, and value language and literacy. Forms of literacy, such as the emphasis on oral versus written language in the Hmong community, or the tradition of history told through Puerto Rican folk ballads, are important. They affect how an individual defines literacy within his or her world and the purposes it accomplishes. Aspects of fixed culture may also shape what the individual hopes to do with enhanced literacy proficiency.
- A person's social and cultural world encompasses a number of "communities" or "chosen affiliations" that use language and literacy in specific ways. The Catholic Church has rites and texts different from those found in an Orthodox Jewish Synagogue or in a Sweat Lodge. Even within each of these groups, the culture varies from region to region. A person belongs to a number of groups (communities) at the same time. An individual must adapt language and literacy to be accepted in each. For example, you use language one way in school, another way at home, another way with your sports team, and yet another way in a professional setting. Successful individuals define and use literacy adaptively in response to social and cultural contexts.
A person's social and cultural world encompasses a number of "communities" or "chosen affiliations" that use language and literacy in specific ways. The Catholic Church has rites and texts different from those found in an Orthodox Jewish Synagogue or in a Sweat Lodge. Even within each of these groups, the culture varies from region to region. A person belongs to a number of groups (communities) at the same time. An individual must adapt language and literacy to be accepted in each. For example, you use language one way in school, another way at home, another way with your sports team, and yet another way in a professional setting. Successful individuals define and use literacy adaptively in response to social and cultural contexts.
Questions developed in our survey were designed around the principles of constructivism, socially constructed knowledge and beliefs, and multiple definitions of literacy and community. As such, they provide a new sociocultural lens that will broaden our perspective on assessment and intervention.
Overview of the Shearer/Nelipovich Sociocultural Survey (SNSS)
Five major categories are included in this assessment tool: A summary of existing information, educational factors, home factors, cultural and social factors, and psychological and affective factors. The information is gathered by conducting an interview with the individual seeking services. The examiner asks for brief answers and records or takes notes. At the end of each section, the examiner analyzes the responses and writes a global, one paragraph summary of factors that will have a positive or negative impact on instruction or probability of success. Following is a brief description of each of the five sections.
Section I: Background Information
Typically, individuals entering a program of adult literacy and blindness rehabilitation will have completed some of the traditional assessments mentioned above. For example, there may be reading level scores obtained by adult literacy educators. There may also be information gathered from visual screening assessments completed by rehabilitation specialists. The professional responsible for coordinating the literacy intervention will first review existing data and extract pertinent facts to serve as the basis for subsequent inquiry and consider, "What do I already know about the individual?," and "What do I still need to know about the individual to create a culturally and socially responsive intervention program?" In Section One, the examiner summarizes test results and information including:
- Information related to the onset of vision loss, residual vision, visual functioning, orientation and mobility, nature of task completion ability in various contexts, need for, access to, and facility with use of various adaptive devices, and visual demands of home, work, and community.
- Information on grade level literacy scores, reading strategies, error patterns, and oral and written language proficiency. Included is a checklist identifying the individual's typical literacy activities, such as engaging in hobbies, reading newspapers, using the Internet, participating in religious reading or ceremonies, organizing finances, shopping, and engaging in other daily literacy activities.
The examiner uses this information to guide the administration of the rest of the survey. Redundancy is built into the instrument, and examiners will recognize instances in which an earlier response may have already addressed an item. The assessment professional will then skip the item to adjust for redundancy.
Section II: Educational Factors
- Educational factors related to visual impairment (Skip this
section for individuals with adult onset of visual impairment.)
Among the questions in this section are the following:
- What are your earliest memories of visual difficulties during early childhood, middle school, and high school?
- How did aspects of vision loss impact your literacy experiences,
attitudes toward reading, and the amounts and types of reading you
did in and out of school?
Educational factors related to literacy
Among the questions in this section are:
- What are your earliest memories related to reading and being read to?
- How did literacy difficulties impact your attitudes, self-esteem, motivation, identity, academic success and daily interests and routines?
- Which literacy tasks can you do easily and which tasks challenge you?
- How do you assess your ability?
Section III: Home Factors
- Home factors related to visual impairment (Skip this section for
individuals with adult onset of visual impairment.)
Questions in this section include:
- During your childhood and adolescence, how did vision loss affect your daily activities, attitudes, interactions with family members, identity, expectations, and feelings of dependence/independence?
- Which tasks were easy and which were challenging?
- What were the home support systems, accommodations, and discussions?
- What were the genetic factors?
- Were there issues of alcoholism, abuse, or lack of parental
encouragement in your home?
- Home factors related to literacy
The questions in this section include the following:
- How did your struggles with reading and writing affect your attitudes and those of family members with regard to expectations about your ability to perform home-related recreational, social, and work-related tasks?
- What was the nature of the literacy activities of your family. and what books or other reading materials were present?
- What impact does limited literacy proficiency have on your relationships with your partner or with reading to your children?
- How will you address your negative feelings about reading so they will cease to be barriers?
Section IV: Cultural and Social Factors
- Cultural and social factors related to vision impairment (For
individuals with adult onset of vision impairment skip the
questions about childhood and adolescence.)
Questions in this section include the following:
- How did your vision loss impact your social life, treatment by peers, friendships, identity, body image, participation in recreation, hobbies, sports, dating, driving, attending movies, and other socially related activities during childhood and adolescence?
- How does your vision loss impact these factors currently?
- To what degree do you identify with a particular ethnic or religious group?
- What are the attitudes and beliefs of these groups about individuals with visual impairment, and what are the support networks within the groups?
- Are there issues related to race, gender, or sexual orientation affected by your vision loss?
- What is your attitude toward individuals with disabilities?
- Cultural and social factors related to literacy
Questions related to this section include the following:
- In your childhood and adolescence, what ways were language and literacy used, valued, and taught in your home?
- What primary and secondary languages were spoken in your home?
- To what degree did the values, beliefs, and uses of language within your home, ethnic group, religious affiliations, and social communities match those of the school and the dominant culture?
- To what extent, if any, did they or do they affect literacy proficiency in positive or negative ways?
- To what extent did your friends engage in and value reading and literacy?
- How would you answer these questions relative to your current home and social environment?
Section V: Psychological and Affective Factors
- Psychological and affective factors related to vision impairment
Among the questions in this section are:
- In what ways has your vision loss affected your identity, self-esteem, body image, emotional development, and social interactions?
- Do you have past or present issues with mental health, depression, alcohol or substance abuse, or domestic violence?
- Are there any aspects for which you would like information or services?
- To what degree do you see yourself as capable, motivated, and willing to try new things or join new groups?
- How motivated are you to learn braille or adaptive methods and technology?
- How comfortable are you asking for help with visual tasks?
- How confident are you in your ability to achieve your goals and
how will you address possible barriers to success?
- Psychological and affective factors related to literacy
These questions include the following:
- In what ways have low literacy skills affected your self-esteem, identity, emotions, desire to read for enjoyment, choice of reading materials, and motivation to improve your literacy skills?
- Which literacy tasks do you enjoy and which are particularly challenging?
- In which contexts have you ever or do you currently hide your lack of literacy proficiency?
- How confident and motivated are you to improve your reading and writing?
- What would you most like to do when you improve your literacy?
- How will you overcome barriers and reward yourself throughout the process and when you reach your goals?
Analyzing the responses
For each of the five sections, the evaluator writes a narrative summary (one paragraph) of a few (not ALL) factors that will have a positive or negative impact on instructional practice or probability of success. The point is to get a global, holistic perspective on the sociocultural factors, not a score.
For each significant factor, the evaluator addresses ways in which instruction will be modified to:
- Meet a need
- Capitalize on a strength
- Bring in the literacies and goals of the community and culture
- Incorporate the individual's social goals.
Factors That Influence the Assessment
A number of factors need to be considered during the information-gathering process. Indeed, the sociocultural factors examined in the survey have powerful implications for the manner in which an individual responds to the interview questions. The education differential between examiner and subject may be socially and culturally intimidating. It is important to recognize that individuals differ according to personality, stamina, tenacity, values, and culture. While some individuals may respond openly, comfortably, and freely during the process, a number of questions are highly personal and may be considered inappropriate in certain cultures, especially if the survey is administered in the first contact session. It may be essential to delay administering the survey until rapport is established through several contacts with an individual whose culture or personality indicates reticence. The examiner may also find it necessary to eliminate certain questions that are likely to be offensive to the subject.
Implications of a Sociocultural Survey
One of the benefits of completing this survey is that the individuals being assessed will undoubtedly gain insights into their beliefs, values, and experiences. We also believe that rehabilitation or literacy professionals must also examine their beliefs, attitudes, and values related to literacy and visual disability. We suggest that professionals reflect on each of the areas of the sociocultural survey to understand their own beliefs, values, and experiences, and the implications of these factors on their interactions with individuals seeking services.
It is essential that we assess an individual's degree of functional vision and functional literacy as we develop programs. In addition, we must recognize the cultural, social, psychological, and physiological factors that determine how individuals make sense of their vision impairments as well as the behaviors and actions they are likely to adopt (Kelly, 1995; Milian & Erin, 2001). As a result of vision loss, they may be struggling with losses in self-esteem, social networks, independence, autonomy, and recreational opportunities (Ryan 2002), all of which will most certainly influence the way they approach literacy intervention and rehabilitation, as well as the outcomes of these endeavors. Identifying sociocultural factors will complete the assessment picture and enable literacy and rehabilitation specialists to develop highly personalized intervention strategies that address barriers proactively, and recognize the individual's multiple literacies and social goals.
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