Sensory & Physical (VI, HI and PI)

The Royal National Institute for the Blind (RNIB) estimates that around 25,000 children and young people up to the age of 16 in England and Wales have a visual impairment (VI) needing specialist educational support. As many as 50 per cent have additional disabilities alongside their visual impairment.

The term visual impairment refers to a number of conditions that can adversely affect near and distance vision, or processing of visual information. Most people who are blind and partially sighted are born with a vision impairment. However, research cited by the RNIB (2016) suggests that there are learners in schools whose visual impairment has not been identified and is more likely to go undetected in learners with additional disabilities.

Learners may experience visual difficulty in a number of ways:

Low acuity: the ability of the eye to distinguish shapes and the details of objects at a given distance. 4 The Graduated Approach to SEN Support – Visual Impairment
Central vision loss: the area of the visual field which is used for detecting fine detail.
Peripheral vision loss: this condition often impacts on a learner’s overall orientation and how they move around and negotiate obstacles.
Patchy vision: as the term suggests, some learners’ sight may be affected by irregular patches of good and poor vision which may mean they are only able to pick up information in disjointed fragments.
Low contrast sensitivity: difficulty picking out an object from its background, particularly in certain light and colour schemes and environments.
Light sensitivity: learners who find strong light conditions difficult and even painful.
Eye movement difficulties: the movement of the muscles in the eye which impacts on the learner’s ability to focus and track objects.
Colour confusion: although not a visual impairment in itself, it may occur alongside other visual difficulties and can vary in severity.
Severely sight impaired (SSI): learners with significantly impaired vision who require substantial modification to the way they access the curriculum.

However, every learner is unique and many of our learners with a visual impairment have some ‘functional vision’. The term ‘functional vision’ is useful as it helps teachers to focus on what a learner can see, rather than what they can’t see and therefore consider how their functional vision can be utilised in different classroom and school situations and also how teaching and support may need to be modified. A learner’s visual impairment may have the potential to impact on:

The ability to access learning and develop unless SEN Support is in place. • Educational progress, particularly in reading and writing.
The speed of working as it may take learners with a VI longer to complete many tasks.
Movement around the school environment.
Their safety when accessing subjects such as science, sport or design technology.
Social interaction, including the ability to pick up on body language and facial expressions and the ability to make and sustain positive friendships.
Self-esteem, particularly where they experience negative attitudes from peers.

Learners with a visual impairment can be at a higher risk of poor outcomes across a range of social and emotional wellbeing indicators too; this is even greater for learners with VI alongside other disabilities.

The RNIB’s evidence-based review (2016) stresses the importance of awareness raising among mainstream teachers of the effects of VI on learning and also support, which includes a focus on developing independence, daily living and social skills, in order that our learners are fully included with their peers, and are well prepared for the transition to independence in adulthood.

If a visual impairment is diagnosed, a detailed assessment should ensure that a holistic profile of the learner’s strengths and needs is identified, not just the primary need. The support provided to an individual should always be based on a full understanding of this holistic profile and will seek to address identified needs using well evidenced strategies and approaches targeted at the areas of difficulty.

The suggested targeted provision outlined within this guidance document, in addition to inclusive high quality teaching as outlined in the audit tool, will support effective teaching and learning for this group of learners. The curriculum approaches and strategies detailed are not prescriptive or exhaustive. They are intended to guide schools as to the type of provision expected within the graduated approach to identifying and meeting special educational needs at SEN Support and should be delivered in accordance with a learner’s assessed needs and agreed outcomes.

The role of the QTVI varies depending on the needs of the children, families, settings and schools they are working with.

The role of the QTVI can include, but is not limited to:

Liaison

health care professionals such as Ophthalmologists and Orthoptists, Health Visitors, Paediatricians, Therapists, ECLO (Eye Care Liaison Officer)
parents/carers, practitioners in early years settings, teachers and SENCOs in schools and 6th form colleges
other professionals such as Educational Psychologists, Special Educational Needs and Disability Officers, Social Workers, Habilitation/ Mobility Officers.

Assessment

of children and young people’s functional vision as well as their development and learning in general
the suitability of specialist equipment to support a child/young person’s access to education
identification of needs, outcomes and provision for children and young people as part of the statutory Education, Health and Care Needs Assessment process.

Teaching

babies/young children and their families at home; children in early years settings; children in schools and 6th form colleges
practitioners in early years settings and teachers and support staff in schools and colleges to model strategies and approaches to enable them to effectively support individual children and young people.
maximising residual vision
developing compensatory skills e.g. tactile skills, braille, accessibility software
communication and interaction
social and emotional support related to vision loss, including self advocacy skills

Advice

to parents, carers and families to enable them to understand the nature of their child’s visual impairment and understand how to support all aspects of their child’s development and learning, at home and in the community.
to staff in settings to enable them to understand the nature and impact of a child’s visual impairment and consider how to modify and adapt their environment, the activities and learning opportunities on offer in their setting, their access to the learning and social opportunities and how best to support them.
to children and young people in relation to their visual impairment, developing their skills as independent learners and support and encourage them to develop skills to advocate for themselves and develop a positive self-image and prepare for life beyond school.
to schools and 6th form colleges regarding access arrangements for tests and exams

Following a referral to the VI team, the QTVI will firstly check the learner’s medical information and will then arrange a meeting with the parents/carers and a functional vision assessment of the child and observations of the child’s visual skills. The QTVI will use the National Sensory Impairment Partnership (NatSIP) Eligibility Framework to provide a guide as to the level of support required for a learner; this is kept under regular review. The school will then be allocated a QTVI to support the school in planning and making appropriate provision for the learner and will provide training for staff as required.

Staff are aware of the impact visual impairment can have on progress across the curriculum, engagement in extra-curricular school and community life, independence, self-esteem and confidence.
All staff should be aware that they have a duty to make reasonable adjustments for all learners with a VI.
Staff know how to adapt teaching and resources to enable the learner with SEND in this area to access, participate and achieve in their lessons.
Subject leaders and Heads of Department use monitoring activities to ensure learners with VI are fully accessing, participating and achieving in their subject area.
Teachers make good use of NATSIP and RNIB new Curriculum Framework for Children and Young People with Vision Impairment (CFVI)

Hearing loss can impact significantly on many aspects of a learner’s development, presenting as difficulties in one or more areas such as speech, language and communication, social communication, progress across the curriculum, engagement in extra-curricular school and community life, independence, self-esteem, confidence and identity. Many learners with a hearing impairment (HI) will require both reasonable adjustments and specialist support and/or equipment to access learning and wider school life so that they can know and feel they fully belong in school and are enabled to thrive.

There are different types of hearing loss including:

Diagnosed fluctuating conductive hearing loss e.g. glue ear
Diagnosed sensory neural hearing loss (permanent damage to the inner ear)
Diagnosed unilateral loss (one-sided hearing)
Diagnosed long term conductive loss (loss from the outer ear into the middle ear)

Conductive hearing loss is where sound waves are not passing fully to the inner ear; this affects the volume at which sound is heard.

Sensorineural hearing loss is where the cochlea is not processing the full frequency of sound. This is more impactful as the child is not just hearing at quieter levels but the messages sent to the brain are distorted.

The level of a child’s deafness can be described in terms of their average decibel (dB) hearing level, or by the terms ‘mild’, ‘moderate’, ‘severe’ or ‘profound’. Based on British Society of Audiology definitions of hearing loss, this is the decibel hearing level range is defined as:

mild (21–40 dB)
moderate (41–70 dB)
severe (71–95 dB)
profound (+95 dB)

Very few deaf children have no beneficial hearing as they may be able to hear some sounds at certain frequencies and loudness. The use of hearing aids or implants may enable them to hear more.

Sounds are made up of different frequencies and are measured in Hertz (Hz). It is the frequency of a sound that affects the pitch that it is heard at, therefore our learners with a hearing impairment may be able to hear sounds at some frequencies better than others.

If you have a learner in your school diagnosed with a hearing loss, their audiologist or specialist teacher will be able to give you more information about the level of their hearing impairment and be able to explain the sounds that they can and can’t hear.

If a hearing loss is diagnosed, a detailed assessment should ensure that the full range of an individual’s strengths and needs are identified, not simply the primary need. The support provided to an individual should always be based on a full understanding of their particular strengths and needs and seek to address them all using well evidenced SEN support targeted at their areas of difficulty.

The suggested targeted provision outlined within this guidance document, in addition to inclusive high-quality teaching, as outlined in the audit tool, will support effective teaching and learning for this group of learners. The curriculum approaches and strategies detailed are not prescriptive or exhaustive. They are intended to guide schools as to the type of provision expected within the graduated approach to identifying and meeting special educational needs at SEND Support and should be delivered in accordance with a learner’s assessed needs and agreed outcomes.

The role of the QToD varies depending on the needs of the children, families, settings and schools they are working with. The role of the QToD can include, but is not limited to:

Liaison

Health care professionals, such as Ear, Nose and Throat (ENT) Consultants, Clinical Scientists, Audiologists, Health Visitors, Paediatricians, Speech and Language Therapists, and specialist organisations e.g. BDA, Deaf CAMHS
Parents/carers, practitioners in early years settings, teachers and SENCOs in schools and 6th form colleges,
Other professionals such as Educational Psychologists, Special Educational Needs and Disability Officers, Social Workers, Habilitation/Mobility Officers, Charity workers e.g. National Deaf Children’s Society (NDCS).

Assessment

Of children and young people’s primary method of communication e.g. speech/BSL/SSE/Makaton,
Of children and young people’s underlying language levels, speech perception, phonological awareness as well as their development and learning in general,
In relation to the suitability of specialist equipment to support a child/ young person’s access to education and the suitability of acoustic environments for their hearing needs,
And identification of needs, outcomes and provision for children and young people as part of the statutory Education, Health and Care Needs Assessment process.

Teaching

Babies/young children and their families at home; children in early years settings; children in schools and 6th form colleges,
Practitioners in early years settings and teachers/support staff in schools and colleges to model strategies and approaches to enable them to effectively support individual children and young people,
Maximising residual hearing e.g. lipreading, use of assistive technology,
Communication and interaction strategies,
Social and emotional support related to hearing loss including the role of deaf identity,
The Personal Understanding of Deafness programme to enable the learner to become knowledgeable about all aspects of deafness and the support that is available at different stages of life.

Advice

To parents, carers and families to enable them to understand the nature of their child’s hearing impairment and understand how to support all aspects of their child’s development and learning, at home and in the community,
To staff in settings to enable them to understand the nature and impact of a child’s hearing impairment and consider how to modify and adapt their environment, the activities and learning opportunities on offer in their setting, their access to the learning and social opportunities and how best to support them,
To children and young people in relation to their hearing impairment, developing their skills as independent learners and to support and encourage them to develop skills to advocate for themselves and develop a positive self-image and prepare for life beyond school,
To schools and 6th form colleges regarding access arrangements for tests and exams.
To schools providing staff training in areas such as Deaf Awareness and Makaton/BSL/SSE

Although most learners with a hearing impairment will have been identified in the early years of life, there may be some who are as yet not identified SENCOs can work with teachers to use this guide when they are raising concerns around a possible HI.

The NDCS suggest that if you work in the early years or a primary school, there is a high chance that a learner in your care will have an undiagnosed hearing loss.
A mild or slight hearing loss can be difficult to identify. Children may respond to questions easily when asked one-to-one and in a quiet environment whilst at the same time not respond to questions asked at a distance and to the whole class.
Temporary hearing loss can fluctuate, meaning that children may display some of the signs on some days but not others.
It is important to view listening not just in terms of whether speech has been heard but whether it has been perceived and understood.
A study by Coventry University, funded by the Nuffield Foundation, found that 25 per cent of its young participants who had reading difficulties showed mild or moderate hearing impairment, of which their parents/carers and teachers were unaware.

Staff are aware of the impact hearing loss can have on speech, language and communication, social communication, progress across the curriculum, engagement in extra-curricular school and community life, independence, self esteem, identity and confidence.
All staff should be aware that they have a duty to make reasonable adjustments for all learners with a HI.
They know how to adapt teaching to enable the learner with SEN in this area to access and participate and achieve in their lessons.
All key staff know how to use hearing and listening equipment in school.
Engagement from school staff with the Personal Understanding of Deafness programme (delivered by the ToD).
Subject leaders and Heads of Department use monitoring activities to ensure learners with a HI are fully accessing, participating and achieving in their subject area.

Learners with a physical impairment (PI) may present with a range of physical needs which can impact upon their learning and social inclusion and can manifest themselves in many ways. PI can be classed as mild, moderate, severe or profound and may fluctuate or be a degenerative condition.

There are many potential challenges for a learner with a physical impairment: • Physical mobility around the school site

Physical access to all areas of the school site
Motor skills and recording work
Pace at which a learner can work
Potentially slower processing
Postural needs requiring specialist equipment to optimise function
Possible underachievement
Possible low self esteem
Potential social isolation
Negative stereotyping
The educational experience of learners with a physical impairment can be impacted by a loss of learning time due to the need for:
Personal care
Medical needs/routines
Medical and therapy appointments
Short/long term absences due to medical conditions/operations
Pain and fatigue

A learner whose physical needs are fully met alongside support for positive relationships, healthy lifestyles and a sense of security is more likely to approach their learning with confidence, which has a direct impact on attainment and vice versa. Schools also need to be aware that provision may have to be adapted from time to time to meet the learner’s changing physical needs resulting from planned surgical interventions or a change in health condition over time.

As detailed an assessment as possible should ensure that the full range of an individual’s strengths and needs are identified, not simply the primary need. The support provided to an individual should always be based on a full understanding of their particular strengths and needs and seek to address them using well evidenced SEN provision targeted at their areas of difficulty under the guidance of the teacher of PI.

The suggested targeted provision outlined within this guidance document, in addition to inclusive high quality teaching, will support effective teaching and learning for this group of learners. The curriculum approaches and strategies detailed are not prescriptive or exhaustive. They are intended to guide schools as to the type of provision expected within the graduated approach to identifying and meeting special educational needs at SEN Support and should be delivered in accordance with a learner’s assessed needs and agreed outcomes.

The role of the Teacher of PI varies depending on the needs of the children, families, settings and schools they are working with.

The role of the Teacher of PI can include, but is not limited to:

Liaison

Health care professionals, such as Occupational Therapists, Physiotherapists and Speech and Language Therapists
Parents/carers, practitioners in early years settings, teachers and SENCos in schools and 6th form colleges
Other professionals such as colleagues within the Sensory provisions, Educational Psychologists, Special Educational Needs and Disability Officers, Moving and Handling Adviser, Social Workers, Family Support Workers

Assessment

Identification of needs, outcomes and provision for children and young people as part of the statutory Education, Health and Care Needs Assessment process
The impact of their physical impairment on learning
Children and young people’s functional mobility as well as their development and learning in general
In relation to the suitability of specialist equipment to support a child/ young person’s access to education

Teaching

Self-advocacy and ownership of physical and health need
Independence and life skills in preparation for adulthood
Social and emotional resilience and development of self-esteem in relation to physical impairment
Communication and interaction strategies
Strategies for adaptations to the curriculum

Advice

To staff in settings to enable them to understand the impact of a child’s physical impairment and to consider how to modify and adapt their environment, the activities and learning opportunities on offer in their setting, their access to the learning and social opportunities and how best to support them.
To children and young people in relation to their physical impairment, developing their skills as independent learners; to support and encourage them to develop skills to advocate for themselves, to develop a positive self-image and to prepare for life beyond school.
To parents, carers and families, to support them in meeting their child’s learning needs and to promote preparation for adulthood.
To schools, regarding appropriate access arrangements for assessments and exams.

Staff are aware of the impact the learner’s physical impairment has on their progress across the curriculum, engagement in extra-curricular school and community life, independence, self-esteem and confidence.
Teaching and Support Staff have physical impairment awareness training (including periodic refresher training) in the learner’s specific area of disability and know how to adapt teaching to enable the learner with SEND in this area to access, participate and achieve in their lessons.
All staff should be aware that they have a duty to make reasonable adjustments for all learners with a PI.
Subject leaders and Heads of Department use monitoring activities to ensure learners with a PI are fully accessing, participating and achieving in their subject area.

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Last updated: 04/08/2023