Comprehensive Emergent Literacy Instruction for Students

Comprehensive Emergent Literacy Instruction for Students with Significant Disabilities, Including Cortical Vision Impairment and Complex Communication Needs by Caroline Ramsey Musselwhite , Deanna Kempka Wagner , Gretchen Hanser

Comprehensive Emergent Literacy Instruction for Students with Significant Disabilities, Including Cortical Vision Impairment and Complex Communication Needs literacy Article Series Summary When and how to make literacy adaptations for students who have complex communication needs combined with Cortical Vision Impairment can be a difficult task that requires systematic interprofessional collaboration. This article series will focus on the 5 daily emergent literacy routines recommend- ed by Erickson (2017): shared reading, Predictable Chart Writing, alphabet/phonological awareness activities, independent writing, and independent reading. To build confidence and meaningful engagement, augmentative and alternative communication is integrated throughout. The following article will provide background knowledge about CVI, CCN, emergent literacy and the trifocus framework. Deanna K. Wagner, MS/CCC-SLP, is a speech-language pathologist with over 30 years experience providing consultations and training in the area of assistive technology with an emphasis on augmentative communication. She works with educators and families to achieve goals in the area of AAC selection and implementation through a contract with TherapyOne (nominated two years in a row for the McLean-Yoder Award for Professional Excellence). She has been recognized for volunteer efforts and AAC support services to adults at the non-profit organization VALLEYLIFE, including various Stories of Ourselves literacy projects. She is co-director of Out and About: AAC in the Community. She has presented at local, national, and international conferences. Caroline Musselwhite, Dr. Caroline Musselwhite is an assistive technology specialist with more than 40 years of experience working with children and adolescents with significant disabilities in a variety of settings, including Head Start, clinics, developmental day programs, homes, and the public schools. Dr. Musselwhite has written a number of textbooks and “how-to” books on a range of topics, and has also authored many books and software programs for youth with disabilities. She has presented thousands of workshops throughout North and South America, Australia, Europe, and Africa, and is a founding member and Fellow of the International Society for Augmen- tative and Alternative Communication. Honors include: Foundation Fellowship (West Virginia University), Educator of the Year (Association for Retarded Citizens, North Carolina), Honors of the Association, (North Carolina Augmentative Communication Association), and DiCarlo Outstanding Clinician Award (North Carolina Speech-Language-Hearing Association), and ISAAC Fellow.. Gretchen Hanser, Gretchen has worked in the field of assistive technology and literacy for students with significant disabilities for over 20 years. She is an educator and an occupational therapist. She has worked in a variety of educational settings developing model classrooms, developing school based assistive technology centers, providing teacher and related service provider trainings, participating in assistive technology assessment teams and working directly with students and staff in the classroom. Her primary focus has been on augmentative and alterna - tive communication and literacy for students with the most significant disabilities. Gretchen has a masters in occu - pational therapy from the University of North Carolina in Chapel Hill and received her doctorate in education from the University of New Hampshire. She presents at local, national, and international conferences.

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Introduction Students with Cortical Vision Impairment (CVI) and complex com- munication needs (CCN) pose a daunting challenge to professionals who are working to build students’ vision, communication and literacy skills. To facilitate student progress, professionals need to share their expertise. Building a solid emergent literacy foundation is essential for later conventional literacy learning. To promote balanced instruction which takes into consideration CVI interventions and comprehensive emergent literacy instruction, this article will provide an overview of CVI, as well as emergent literacy. To foster inter-professional collabo- ration, a trifocus model will be described to plan instruction that con- siders the learner, partner and environment. Five broad instructional strategies are emphasized in the trifocus framework proposed by Bruce and Bashinski (2017): enhancing (partner) sensitivity, utilizing routines, increasing communication opportunities, modifying the communica- tion environment, and augmenting input. These principles will be in- terwoven throughout this article.

Cortical Vision Impairment Characteristics and General Literacy Implications Professionals and communication partners need to understand and be sensitive to the impact of CVI in order to design the most appropriate literacy instruction and presentation of literacy materials. CVI is a neu- rological disorder which impacts the visual processing of information in the brain. It is frequently undiagnosed or unrecognized due to multiple physical/cognitive impairments. In the past decade, knowledge about CVI has grown rapidly (Roman, 2018; Lueck & Dutton, 2015). Observing a particular routine/task from the visual perspective of the learner can help guide interprofessional collaboration when designing adaptations. According to Roman-Lantzy (2018), there are 10 CVI Characteristics that can be measured by the CVI Range Assessment Tool (see Table 1 for char- acteristic descriptions and general literacy implications). Students’ abili- ties within and across the characteristics determine their severity of CVI. The 10 characteristics can be used to guide intervention and adaptations, using the CVI Characteristics: Teaching Strategies and Accommodations Planning Guides, found here (http://cvi.bridgeschool.org/interventions/).

Description

Literacy Implications

Characteristics

Color Preference

There may be specific colors that attract stu- dents vision

Preferred colors can be used within a literacy activity to facilitate visual interest

Visual Field Preferences

There are certain fields where students may not be able to see.

Identify the fields where students can see in order to effectively position literacy materials A personal tablet/screen may provide backlight that improves ability to sustain visual attention during reading and writing tasks Use digital books with animation. Reflective tape around the edges of a personal screen/tablet can draw visual gaze as the device is moved from peripheral to the student’s central vision Consider degree of complexity in books and other liter- acy materials. Use masks or occluders to minimize clutter When making activities, use pictures that are familiar to student. Choose media that allows a person to record a verbal description of the picture (salient feature descrip- tion) If students have trouble using their hands to manipu- late literacy materials, identify a different position or dif- ferent way for student to access materials, such as through using switches Give students uninterrupted time to look at books and other materials

Need for light

Students may stare up into the lights

Need for Movement

Students may need an item to move in order to get their visual attention

Visual Complexity

Students have difficulty with processing things with a busy, complex background.

Visual Novelty

Students don’t notice new things in their environment

Difficulty with Visually Guided Reach

Students may have difficulty reaching for some- thing while using their vision to guide their hand.

Visual Latency

Students may take a long time to process visual information . Students may have a delayed blink reflex. This is used for evaluation purposes only. Students have difficulty with complexity of array when viewing items at a distance

Atypical Visual Reflexes

No intervention strategies improve this reflex

Difficulty with Distance Viewing

Presenting information with a projector or Smart Board may not be visually accessible. Using a personal tablet/ screen or focusing on auditory input may be necessary during group time.

Table 1: CVI Characteristics and General Literacy Implications

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Students’ performance ratings on the characteristics are used to classify their level of CVI. In broad terms, Roman-Lantzy (2019) refers to 3 different phases of severity of CVI. Phase 1, Building Visual Behaviors, describes students who have little functional vision and are learning to simply use their vision to look at something. Phase 2 describes a student in general terms who is learning about Integrating Vision and Function, figuring out what they are looking at and attaching meaning. Phase 3 describes a student who has a great deal of vision but requires specific instructional support as he/she is Developing Visual Cu- riosity. Common Classroom Observations of Students with CVI Students with CVI may not be able to look where the teach- er points, and are often seen looking elsewhere, or not looking at all. Some students may seem to be focusing on items in the environment that are not part of instruction, gazing up at lights or fans, watching shadows or other people moving around the room. A student who is listening hard when a story is being read may have his head down with eyes closed, and is definitely not looking at the book or the teacher. Another student might be rocking back and forth in her chair, using movements of his/her own body to stimulate peripheral vision. Often these observa- tions my be interpreted as behaviors, when they are really a re- sult of the student’s CVI. Empathy and sensitivity, getting down and looking at the classroom from the student’s perspective, is required to fully understand what the student is doing and why he is doing that. Only then can we design productive learning environments for these students. As is necessary for all students, the support team should col- laborate on how to modify instructional materials and activities. Team members should consider use of the CVI Characteristics: Teaching Strategies and Accommodations Planning Guides found here (http://cvi.bridgeschool.org/interventions/). On this form, each of the CVI Characteristics is listed with places for the team to fill in the teaching strategies and accommodations. Consider the characteristic of difficulty with distance viewing as an example. A student with mild CVI may be able to see 4-6 letters at a time when they are presented on a backlit tablet that is nearby. That same student may need letters presented larger and only one or two at a time during small group instruc- tion. During large group instruction visual functioning may be extremely limited due to auditory distractions or other people moving around the room. Therefore, one student may need to have access to multiple accommodations during the school day in order to participate fully in emergent reading and writing ac- tivities by actively manipulating the letters and sounds of the al- phabet, recognizing patterns of connected words, and getting/ making meaning from stories. Many students with cortical vision impairment have difficul- ties visually processing photographs of faces, and may struggle

to read facial expressions in real life. They may also be unable to visually follow where somebody is pointing to establish a joint reference when communicating with a partner. This may impact how their social-linguistic skills develop. Utilizing routines and increasing familiarity with materials by providing consistent vi- sual descriptions can be beneficial. Engaging in the process of writing and sharing personal experience stories (Hagood, 2014) and home-school journaling (Mogan, 2018) can be used as a context for building social-linguistic skills (Wagner, 2019). It is easy to see how CVI can get in the way of students’ litera- cy learning. However, students’ vision must not be a roadblock or a gatekeeper to rich, authentic literacy opportunities. There are multiple facets to literacy development, many of which don’t require vision. In addition to the CVI characteristics, profession- als need to have enough knowledge about the details of literacy development in order to design instruction, starting with emer- gent literacy. Overview of Emergent Literacy The term emergent literacy describes the process of begin- ning, exploratory reading, and writing experiences of children before they learn to formally read and write (Teale & Sulzby, 1986). Emergent literacy is not about identifying sight words, phonics instruction, spelling words, or taking comprehension tests—these are all conventional literacy skills. Instead, emer- gent literacy refers to the foundational experiences that prepare children for such conventional instruction once they enter ele- mentary school. Teale and Sulzby (1986) outlined four principles that apply to the earliest stages of literacy learning, all of which have important implications for how we design literacy instruc- tion for students with CVI. These key principles are described, followed by implications for students with significant disabilities (Koppenhaver, Coleman, Kalman, & Yoder, 1991). No Student has to be Ready for Literacy: Literacy Learn- ing Begins at or Even Before Birth With this concept in mind, most children are exposed to liter- acy before they even know what to do with it. Many parents cre- ate environments filled with books, crayons, print-rich toys, and even print-rich clothes and room decorations. Children cannot help but not see print all around them (e.g., labels, signs, recipe books, mail, posters). They also see others using print (e.g., dad writing a shopping list, mom reading the newspaper). Adults read to children, often over and over; some parents even read to their children in utero. These rich experiences are ongoing and numerous; in fact, some children have more than 1,000 hours of these early print-based interactions by the time they begin school. (Heath, 1983). Through this emergent lens, it is clear that children are born “ready” for literacy (Teale & Sulzby 1986).

Implications for students with significant disabil- ities: No student, regardless of their disability and

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Literacy Learning Occurs When Children Are Actively En- gaged Children’s overall success in learning is dependent on their ability to actively engage in each of the areas described in the above section. Young children without disabilities learn by ac- tively “doing,” and without question are given free rein to ex- periment with books, crayons, and other literacy materials. In the beginning, children do not have a clear sense of what to do with these items, and their physical abilities to manipulate them are limited and random (e.g., holding books upside down, eat- ing or scribbling with a crayon). Their exploration of materials is encouraged, and over time they become more refined. Children learn about writing by writing. Children learn about books by using books. Implications for Students with Significant Dis- abilities: Due to the nature of their disabilities, these students tend to be passive observers. Professionals need to identify methods and appropriate materials that students can easily explore. Assistive technology plays a necessary role. For example, students may be unable to physically use their hands to explore books, and may benefit from using switches to turn pages in digital books on the computer or iPad. For students who cannot see the page, many digital books offer a read outloud feature. Environmental considerations will include evaluating how background noises and move- ment affect visual concentration as some students with CVI cannot look and listen at the same time. To support writing, students will need some form of “alternative pencil,” which does not require hand use to form letters (Erickson & Hanser, 2004). Alternative pencils consist of a paper or electronic keyboard from which students choose letters. Alternative pencils can be easily modi- fied to accommodate students who have even the most severe CVI, for example, using reduced letters arrays and highlighting the letters using the glow feature in Microsoft Word. (See Figure 1) Different “pencils” may be used throughout the day. Partner sensitivity to levels of visual fatigue or stress should take advantage of routines as the multidisci- plinary team discusses how to modify the environment or writing task to reduce distractions and improve performance at various times during the day. For more information about alternative pencils see: The Center for Literacy & Disability Studies, University of North Carolina-Chapel Hill, www.med.unc.edu/ahs/clds. The Functions of Literacy are Just as Integral to Literacy Learning as the Forms Not only do most children learn the different ways to form print/Braille, they also learn that print has a function—it conveys

cognitive status, needs to be “ready” for comprehensive literacy instruction (Erickson, 2000). Our task is not to determine “readiness” of the student, , but we do need to ensure the “readiness” of the environment and the right materials to provide rich literacy exposure and experiences that are meaningful and accessible to all of our students. Reading, Writing, Speaking, and Listening Abilities are In- terconnected and Develop Simultaneously Their interconnectedness can be demonstrated in the most common of emergent literacy experiences, such as reading stories to young children. This shared experience imparts a wealth of knowledge to children, such as the purpose of books and what it means to be a reader, as well as providing a time to bond with a trusted caregiver. Children use what they have seen about the print in books to construct their own books through experimenting with writing. Shared reading is rarely a quiet time; instead it is an enjoyable, interactive activity that facilitates children’s speech and cognition. Children build their vocabulary and are encouraged to label pictures, comment, and ask ques- tions. Adults respond to children with explanations of words and important concepts from the book. Thus, reading contributes to children’s abilities to write, speak, listen, and develop important receptive language concepts. Implications for Students with Significant Dis- abilities: Each of these areas need to be addressed in students’ daily literacy instruction, most notably com- municating and writing. Students who have difficulty speaking should be learning to communicate using some form of augmentative and alternative com- munication (AAC). In order to have the types of rich interactions and conversations as their speaking peers, AAC systems need to be robust (including generic/ functional core words, personally meaningful topic- or category-associated words/phrases, and all letters of the alphabet). To learn to express individual thoughts, students need to learn how to use the letters of the al- phabet for writing. Too often, students with significant disabilities are not given opportunities to write with the full alphabet as professionals may perceive writing as too cognitively or visually challenging. However, as seen through an emergent literacy lens, learning to communicate and write with accuracy is not the imme- diate goal. No different than young children without disabilities, when exploration and experimentation is encouraged, concepts are built and skills develop through interactions with a more knowledgeable com- munication partner.

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Figure 1: Sample page from a modified Print Flip Chart with letters that have the “glow” font effect in Microsoft Word.

a message. Print/Braille is used for a variety of functions, such as sharing information (making a shopping list), giving instructions (reading signs) and fostering relationships (writing e-mails and letters). Early on, adults teach children about these functions without much deliberate thought. Children’s early motor skills are awkward and unrefined; however, their development is fa- cilitated by the meanings that adults ascribe to the unrecogniz- able scribble. For example, while sitting next to a parent making a grocery list, the child makes a random mark. The parent may attribute meaning to the child’s attempt, praising him/her for the list addition. Taking the list to the grocery store and using it teaches the child about the functions of print, Even though their writing is not recognizable, it conveys an idea and some- thing important happens. Implications for Students with Significant Disabili- ties: Instruction for students with significant disabilities including CVI may tend to focus on the form and shape of letters and words rather than their functions in a variety of contexts. This can lead to isolated, splinter skills. Personally meaningful writing activities that are authentic, such as home-school journaling (Mogan, 2017), can lead to greater understanding of “why” we are writing down thoughts rather than focusing on the form of letters. Barriers to Literacy Instruction for Students with Significant Disabilities While the principles of emergent literacy have been de- scribed in the previous section, there may be barriers that pre- vent students from receiving this kind of quality, comprehensive

instruction. •

Professionals may have a “readiness” view of literacy. As a result, students may be given limited opportunities to ex- plore a wide assortment of literacy materials. This occurs most frequently with writing with the full alphabet. Assis- tive technology plays a huge role in giving students access to such basic activities, ie. alternative pencils modified for students vision and physical needs,. • Literacy instruction may have a strong focus on building vi- sion. As a result, the scope of literacy instruction may be limited to what the student can see or what they are work- ing on seeing. However, students can be taught a wide range of literacy concepts through auditory channels. • Students don’t get the appropriate type of instruction. Stu- dents may receive conventional literacy instruction when they should be receiving emergent literacy instruction. Al- though emergent literacy is a necessary foundation, pro- fessionals may not know the difference between emergent and conventional literacy instruction, so they try to simplify conventional instruction. However, within the field of liter- acy for students with the most significant disabilities, emer- gent literacy instruction has been documented as an effec- tive approach (Erickson, Clendon, Abraham, Roy, & Van de Carr, 2005; Erickson, 2017). • Daily instruction might be limited to mechanical skills (e.g., identifying letters and sounds), rather than comprehensive emergent literacy opportunities. • Students have limited opportunities to to explore robust AAC systems which contain vocabulary for commenting, protesting, questioning, and communicating about books using adjectives and verbs. Vocabulary may be limited to

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Emergent Literacy Instruction and the Trifocus Approach to Communication

what they can see and/or touch with their hand. As a re- sult, vocabulary may be limited to a few basic needs, which limits rich conversations during reading and writing. How- ever, interprofessional collaboration (Bruce & Bashinski, 2017) can consider different strategies to minimize the vi- sual complexity while still having access to a robust AAC system. Examples: hiding/showing vocabulary (teacher/ SLP), systematic branching which decreases number of vi- suals while branching to more vocabulary (SLP), increased spaces between cells or use of switches (OT, PT), and use of auditory prompts (teacher/SLP). (See Figure 2 and 3 - Core Word Displays) Comprehensive Emergent Literacy Instruction for Students with Significant Disabilities While students with significant disabilities have had extreme- ly limited emergent literacy experiences, there is direction from the field that can guide appropriate instruction. Erickson (2017) recommends the following daily activities for learners who are at the emergent literacy level: • Shared Reading, • Predictable Chart Writing, • Alphabet and Phonological Awareness, • Independent Writing with the whole alphabet, and • Self-Directed Reading. Literacy is a complex process and requires learning in many different areas in order for students to truly grasp and internalize what it means to be a writer and a reader. Upcoming articles in this series will focus on each area in depth with details about the “what and how” of implementing the activities with students with CVI. A critical element of the “how,” will be understanding how CVI characteristics affect access to learning opportunities for each student. The sections below describe how consider- ations of the learner, partner and environment can be reviewed in our efforts to enhance partner sensitivity.

Including students with CVI and CCN in literacy learning in- volves considering their communicative attempts and requires highly individualized approaches. Any attempt to describe how a learner is functioning and what adaptations are neces- sary must also consider the communication partner and envi- ronment. Bruce & Bashinski (2017) offer these five strategies to guide interprofessional collaborative practice (ICPC): • Building Partner Sensitivity - can foster feelings of empa- thy and lead to greater mutual understanding A teacher who understands why a student closes his eyes when listening will recognize times when the stu- dent is listening and when she can be encouraged to look (without other competing distractions). The teacher can learn to respond consistently to the non-symbolic or id- iosyncratic signals that the student uses for expression. • Using Instructional Routines - can reduce stress and pro- vide a context for learning Once a student is comfortable with a repetitive routine that is naturally or regularly occurring, he/she is more like- ly to notice when/where changes occur. For example, a predictable song or story can be modified with differ- ent sounds and/or letters for each student in the class. • Increasing communication opportunities - can increase interest and engagement Students can be given frequent opportunities to ex- press themselves for multiple purposes (e.g., giving opinions, asking questions, denying/protesting, etc.) • Modifying the communication environment - can im- prove function Performance improves when materials are adapted to address visual needs and environmental context is also considered (e.g., using non-glare laminate when creating high contrast

Figure 2: Core Word Display - Template 1

Figure 3: Core Word Display - Template 2

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materials, reducing visual clutter and increasing empty spac- es between items, presenting items in preferred visual field)

decide on students’ general emergent literacy needs.

Partner Assessment/Considerations Students’ receptive and expressive language learning may be affected by limited ability to watch and learn from others. Con- versational partners (including instructional staff) need to care- fully consider the complexity of language they use when inter- acting with a student who does not have typical vision. Partners who are more sensitive to idiosyncratic communicative efforts respond in ways that are more empathetic and understanding of how vision affects learning concepts and communication. Scripting the language of instruction can help build trust, antic- ipation of routines, and confidence to take risks in learning new tasks. As the team is considering how to integrate emergent lit- eracy instruction into a daily schedule, team collaboration is crit- ical to determine the methodology and routines for modeling language, particularly if the student does not have clear speech and will need some form of augmentative communication. The AAC Profile (Kovatch, 2009) and/or AAC Portfolio (VanTaten- hove, 2014) can be used to guide discussions about how team members are supporting various levels of communicative skill. The student’s ability to successfully participate in literacy ac- tivities may also be influenced by what the partner is doing, as well as the arrangement of the learning environment and mate- rials. When a student is experiencing visual fatigue, sometimes brought on by competing sensory input, the partner may rec- ognize that in some instances it will be more functional to use an auditory only approach, without requiring visual attention. Partners (whether peers or instructional staff) may need to posi- tion themselves or materials appropriately to address difficulties with distance viewing, light gazing or visual field deficits. Visual clutter (complexity) may be a factor either because the array is too complex or because items are too far away. To reduce chal- lenges with distance viewing, the team may consider: 1) tools for video modeling, 2) scripts for video modeling to maintain predictability, and 3) a quiet time/place for the student to watch the playback videos on his/her own. See 2019 Tip #2 Making Movies on your iOS Device for more ideas (http://www.aacinter- vention.com/page/180009852/180117546/Tips-2019#tip%20 2%202019). Environmental Assessment/Considerations: Environmental modifications during emergent literacy tasks may include re- ducing visual distractions of other people moving around the room, or auditory distractions of other people speaking while the student’s attention is focused on looking. Some students are unable to look and listen at the same time. Depending on the time of day, medication effects, and environmental distrac- tions, the student may need to have a visual break. During these times the student can primarily listen, such as listening to an electronic version or a partner reading the story he/she chooses rather than doing the visual hard work of looking at the pages/ text. Resources for considering the complexity throughout the

• Augmenting input - can help a student understand his/ her world Materials can be presented in combination with verbal de- scriptions, touch cues, gestures, object cues or symbols, pro- vided all communication partners agree to do so in a consis- tent way. Maximizing Engagement in Emergent Literacy Activities When and how to make adaptations for students who have CCN and CVI can be a difficult task. Just knowing the 5 recom- mended daily emergent literacy routines is insufficient. Interprofessional collaboration supports understanding how vision affects conceptual learning, how experiences drive lan- guage learning, and how critical self-directed engagement is to literacy learning. Daily emergent literacy activities should be integrated with exposure to and active experiences with sym- bol-based communication systems. Any adaptations intended to support students with CVI during literacy-based activities must be considered within a trifocus framework: learner, partner and environmental considerations. Learner Assessment/Considerations Using an AAC Profile (Kovach, 2009) and/or AAC Portfo- lio (VanTatenhove, 2014) can document the student’s use of multi-modal forms of communication for multiple functions, re- ceptive and expressive linguistic levels, current ability to operate a speech generating device, and social skills. Considerations for all literacy activities can include modi- fications based on how CVI characteristics affect the student’s ability to functionally participate. Team members should con- sider salient feature instruction and use of the CVI Characteris- tics: Teaching Strategies and Accommodations Planning Guides found here (http://cvi.bridgeschool.org/interventions/). To assess emergent literacy, The BRIDGE is an observational portfolio rating scale that can provide a window into emergent literacy tools and tasks. It measures students’ emergent literacy knowledge in the following areas: foundations of reading, foun- dations of writing, alphabet knowledge, phonological / phone- mic awareness, and oral language (related to literacy activities). The BRIDGE assessment was developed as an assessment tool for preschoolers with disabilities (Pierce, Summer, & O’DeKirk, 2009) and has been modified by Erin Sheldon (www.aacinter- vention.com / 2019, Tip # 3) to support learners of all ages, in- cluding students with complex communication needs. Another tool to help identify a starting point is the All Chil- dren Can Read: Literacy Skills Checklist found at: http://literacy. nationaldb.org/index.php/literacy-development-continuum/. This is an easy to use observational checklist that helps teams

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school day can be found in the “What’s the Complexity” chapter by Tietjen (2018) and in the Bridge School Intervention Plans, under “Guide to Planning Accommodations Across the School Day.” Pulling it All Together As described in previous sections, all team members have a role in maximizing engagement and providing meaningful emergent literacy experiences for our students. This case exam- ple highlights how team members must take into consideration the communication partners and environment when making adaptations for CVI. It is impossible to describe learner needs and abilities without also considering how the environment has been modified and the role of communication partners. Amy and Jonas are both in a preschool classroom with stu- dents who have multiple disabilities, many of whom have some type of vision impairment along with significant cognitive de- lays. Amy has cerebral palsy, spastic quadriplegia, and mild CVI. Jonas had a brain injury as an infant and experiences more profound visual and auditory processing challenges. The pro- gram receives support from the state deaf-blind project and a teacher of the visually impaired, in addition to the SLP, OTR, and PT. Classroom materials are being adapted following team col- laborations that consider student preferences for types of media presentation. The team is working on using personal experience stories and home-school journaling for self-selected reading as well as providing a personally meaningful context for daily shared reading/writing tasks (including predictable chart writ- ing). Although her scores indicate a mild CVI, Amy is definitely a visual learner. She likes looking at pictures on her mom’s phone, raking her hand across the display to change the photos. Due to her motor challenges, she can’t really manipulate the cards with tactile enhancements that her teacher made for Jonas to represent names of their classmates. She needs to learn how letters of the alphabet work, but can’t see when her mom types on the phone. She was recently evaluated for a personal com- munication system since she is also physically unable to express herself verbally. The team will collaborate on adapting the al- phabet pages to make sure Amy can visually distinguish and physically target the letters. Her teacher uses a backlit tablet for instruction. When the teacher (or an instructional assistant) is modeling how to use the letters of the alphabet during a group session, they will need to consider the complexity of the array for distance viewing. One letter presented at a time, using glow coloring on a black background (so it looks like neon lights), is recommended during group instruction so that both Amy and Jonas can benefit. Communication partners will need instruc- tion on how to provide verbal choices/instructions or feedback for each student, based on individual needs. According to the occupational therapist, Amy will be able to visually discriminate and physically target more than one letter or symbol per page on her personal communication system, particularly since the

arrangement will become more and more familiar over time. At first, this option may only be appropriate when other students are not moving around or making a lot of noise, as Amy has trou- ble with coordination due to her cerebral palsy and startles to loud or sudden sounds. She also has trouble focusing her vision, even her near vision, when there are a lot of auditory distrac- tions. Jonas will benefit from presentation of the alphabet one letter at a time, even in settings where there are no other distrac- tions. The team will meet to consider whether auditory cues or tactile enhancements, such as adding textures or Braille, will be beneficial. In addition to modifying their letter boards, the team will also make alphabet books that include video models of se- lecting letters, using verbal descriptions that have been agreed upon by the team. These videos can be used to supplement partner models, since watching another person model use of communication displays or letter boards would be too visually complex for both Amy and Jonas. Summary Emergent literacy is a necessary foundation for the devel- opment of conventional literacy. Students with significant dis- abilities with CVI need rich, authentic emergent literacy oppor- tunities which teach them the joy and power of literacy. When designing instruction that will support students’ CVI, the learner, the partner and the environment need to be considered. Pro- fessionals need to ensure that the during literacy activities, the appropriate accommodations are made so that students’ CVI needs do not limit literacy learning. The most powerful com- mon thread across all of these concepts is the power of the social interaction with others around personally meaningful accessi- ble materials for many different types of literacy activities. With these things in place, there can truly be literacy learning for all! References Bridge School authors (undated). Critical Considerations of All CVI Intervention Plans. Retrieved from http://cvi.bridges- chool.org/interventions Bruce, S.M. & Bashinski, S.M. (2017). The trifocus framework and interprofessional collaborative practice in severe disabili- ties. American Journal of Speech-Language Pathology, 26 (2), 162-180. Buell, L. (2019). Making Movies on Your iOS Device [web log entry]. Retrievable from http://www.aacintervention.com/ page/180009852/180117546/Tips-2019#tip%202%202019 Erickson K.A. & Hanser, G. (2004). Writing with Alternative Pencils CD. Chapel Hill NC: Center for Literacy and Disabilities Studies, University of North Carolina. https://www.med.unc. edu/ahs/clds/products/available-for-purchase/ Erickson, K.A. (2000). All children are ready to learn: An emer- gent versus readiness perspective in early literacy assessment. Seminars in Speech and Language 21(3): 193-202. Erickson, K.A. (2017). Comprehensive literacy instruction, in-

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terprofessional collaborative practice, and students with severe disabilities. American Journal of Speech-Language Pathology, 26, 193–205. Erickson, K.A., Clendon S., Abraham L., Roy, V. & Van de Carr, H. (2005). Toward positive literacy outcomes for students with significant developmental disabilities. Assistive Technology Out- comes and Benefits, v2 n1 p45-54 Fall 2005 Hagood, L. (2014). Play-Based Experience Stories [web log entry]. Retrieved from http://www.pathstoliteracy.org/blog/ play-based-experience-stories Koppenhaver D.A., Coleman P. P., Kalman, S. & Yoder, D. E. (1991). The implications of emergent literacy research for chil- dren with developmental disabilities. American Journal of Speech-Language Pathology. September, 38-44. Kovach, T. (2009). AAC Profile. Pro-Ed, Inc. Available for purchase here: https://www.proedinc.com/Products/34010/ aacp-augmentative--alternative-communication-profile-a-con- tinuum-of-learning.aspx Lueck, A. & Dutton, G. (2015). Vision and the Brain: Under- standing Cerebral Visual Impairment in Children. Arlington, VA: AFB Press. Mogan, M. (2018). Home-School Journals [web log entry]. Retrieved from http://www.pathstoliteracy.org/blog/school- home-journals# National Center on Deaf-Blindness, All Children Can Read: Lit- eracy Skills Checklist. Retrieved from: http://literacy.nationaldb. org/index.php/literacy-development-continuum/ Pierce, P., Summer, G. & O’DeKirk, M. (2009), The Bridge: An Authentic Literacy Assessment Strategy for Individualizing and Informing Practice with Young Children with Disabilities Young Exceptional Children, v12 n3 p2-14. Roman-Lantzy, C. (2018). Cortical Visual Impairment: An Ap- proach to Assessment & Intervention (2nd ed). Arlington VA: AFB Press. Roman-Lantzy, C. (2019). Cortical Visual Impairment Ad- vanced Principles. Arlington, VA: AFB Press. Sheldon, E. (2017). A DRAFT Adapted/Modified BRIDGE for Students With Complex Needs. (Adapted from The BRIDGE, an observational portfolio rating scale by Pierce, Summer, O’DeKirk, 2005). Retrieved from www.aacintervention.com / 2019 Tip # 3. Teale, W. H., & Sulzby, E. (1986). Emergent literacy as a per- spective for examining how young children become writers and readers. In W. H. Teale & E. Sulzby (Eds.), Emergent literacy: Writ- ing and reading (pp. vii–xxv). Norwood, NJ: Ablex. Tietjen, M. (2019). What’s the complexity? In C. Roman-Lan- sky (Ed.), Cortical Visual Impairment Advanced Principles, (pp. 92-159). Arlington, VA: AFB Press. VanTatenhove, G. (2014). The Student Augmentative and Alternative Communication Profile & Portfolio. Retrieved from http://www.vantatenhove.com/files/papers/DataCollection/ StudentAACProfilePortfolio.pdf Wagner, D.K. (2019, June 16). Stories of Ourselves: Building

Social-Linguistic Skills of Learners with CVI [web log entry]. Retrieved from http://aacgirls.blogspot.com/2019/06/sto- ries-of-ourselves-building-social.html

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