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The Situation Analysis of Blindand Visually Impaired Children

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Contact BCVI for more information atLions BuildingPrincess Margaret DriveBelize City BELIZE, Central America Phone: (501) 636-1130Fax: (501) 223-2880 http://www.bcvi.org http://www.facebook.com/bcvi.belize

or

UNICEFOne Coney Drive3 rd Floor, Belize CityWeb: www.unicef.org/belize/Facebook: http://on.fb.me/ZrBH0RTwitter: http://twitter.com/unicefbelizeYouTube: http://www.youtube.com/user/unicefbelize

Acknowledgment

Thanks to BCVI for affording me the opportunity to conduct this Situational Analysis. It was an interesting activity given that I have recently done a broader situational analysis of children with special needs. I am indebted to Mrs. Joan Musa, Executive Director of BCVI and Carla Musa, Programme Officer of BCVI for their guidance, as-sistance, and accommodation rendered to the process.

Mrs. Samuels made this study possible by giving me background information and coordinating all my visits to children, homes and schools. She also accompanied me on visits in Belize City, as well as in the Stann Creek, and Toledo districts. The loca-tion of the children was not a deterring factor. We went all the way to San Benito Pointe which is one of the most remote villages in the country. It is located near the Guatemalan border in the Toledo District. During our travels we had many interest-ing discussions of issues related to children who are blind or visually impaired. I am also very grateful to the Regional Field Officers (RFOs) who went with me to the blind and visually impaired children and their families and schools. Thanks Liza Williams, Shamira Carrillo, Leeann Ayala, and Carla Avila for your stanch support.

I appreciate the cooperation I got from the parents to interact with their children and for their honesty in answering questions regarding the condition of their children and the support they receive. It was a pleasure to have spoken with the parents who were very excited about their children. Most of the children were friendly and responsive. One of them (Gabriel Villacorte) even gave me and Liza (RFO) each a young coconut in the husk to take home. To them, I say “Thank You.” I am also thankful for the bond that developed with many of these children and their families, some of which will be forever.

To all others who contributed to the successful completion of this study I want you to know that I am appreciative of your contribution.

Dr. Roy YoungConsultantJune 2012

This Situation Analysis of Blind and Visually Impaired Children Study was commissioned by Belize Council for the Visual Impaired (BCVI) and funded by United Nations Children’s Fund (UNICEF).

BCVI and UNICEF gratefully recognise the work of Con-sultant Dr. Roy Young as well as the participation of or-ganizations and individuals for their tireless work in pro-viding services and advocating for the equal rights and opportunities of children with disabilities to lead a fulfill-ing life and contribute to the social, cultural and econom-ic vitality of our communities.

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Table of ConTenTsAcknowledgment ........................................................................................................................................ 3Definition of Terms ..................................................................................................................................... 5Acronyms..................................................................................................................................................... 61.0 Introduction .......................................................................................................................................... 82.0 Background ........................................................................................................................................... 93.0 Purpose of the Study ........................................................................................................................... 104.0 Methodology ........................................................................................................................................ 115.0. Visually Impaired Child (0 to 17) ........................................................................................................ 12

5.1 Education ......................................................................................................................................... 12 5.1.1 Zero to Younger Than Three ...................................................................................................... 12 5.1.2 Three to Under Five ................................................................................................................. 13

5.1.3 Five to Fourteen ........................................................................................................................ 14 5.1.3.1 Schooling................................................................................................................................... 14 5.1.3.2 PSE and BJAT Examinations.................................................................................................... 16 5.1.4 Fifteen to Under Eighteen ........................................................................................................ 17 5.1.5 Training Camps.......................................................................................................................... 17 5.1.6 Volunteers ................................................................................................................................. 17 5.2 Training for Service Providers.................................................................................................. 17 5.2.1 Teacher Training ........................................................................................................................ 17 5.2.2 NaRCIE IRO Training ................................................................................................................. 18 5.2.3 BCVI RFO Training .................................................................................................................... 18 5.3 Health ............................................................................................................................................... 18 5.4 Overview of the children who are blind and visually impaired.................................................... 206.0 Prevalence of Blindness and Visual Impairment in Children in Belize............................................. 217.0 NGOs and CBOs that support children who are blind and visually impaired .................................. 218.0 Child Protection ................................................................................................................................... 259.0 Legislation............................................................................................................................................. 2510. Findings................................................................................................................................................. 2711. Recommendations................................................................................................................................ 2912.0 References............................................................................................................................................ 31 Appendix A: Information on Braille ...................................................................................................... 32 Appendix B: Persons Consulted/Interviewed ....................................................................................... 37 Appendix C: Training Program for BCVI’s RFOs.................................................................................... 40 Appendix D: Data Collection Instruments............................................................................................. 41 Questionnaire for Teachers/Principals of Schools................................................................................. 41 Questionnaire for Students.................................................................................................................... 41 Questionnaire for NGOS, CBOS and FBOS........................................................................................... 41 Appendix E: Aims of the Early Childhood Education........................................................................... 42 Appendix F: Children at Increased risk of Disability............................................................................. 43

boxesBox 1: The Challenges and Successes of Jiyah Thomas. ....................................................................... 19Box 2: The Story of Jane Doe.................................................................................................................... 20Box 3: Article 23 of the Convention on the Rights of the Child. ............................................................ 29Box 4: Education laws related to children with special needs. ............................................................. 30

Tables Table 1: Students visited by Level and District......................................................................... 11Table 2: Number of children with different types of visual impairments............................... 22Table 3: Causes of visual disabilities among children.............................................................. 23Table 4: Children who are blind and visually impaired by district and area. ......................... 23Table 5: Number of children who are blind and visually impaired by level of education...... 24Table 6: Children who are blind and visually impaired in school by district and area........... 24Table 7: International agreements relevant to children who are blind and visually impaired............................................................................ 26

DefiniTion of TermsBlind: is defined as the best corrected vision in the better eye of less than 10/200 or visual field of less than 10 degrees in the better eye.

Braille: Braille is a writing system which enables people who are blind or partially sighted to read and write through touch. It was invented by Louis Braille (1809-1852), who was blind and became a teacher of the blind. It consists of patterns of raised dots arranged in cells of up to six dots in a 3 x 2 configuration. Each cell represents a letter, numeral or punctuation mark. Some frequently used words and letter combinations also have their own single cell patterns. See Appendix A for further discussion of Braille.

Child: A child is a person below the age 18 years.

Community Based Rehabilitation (CBR): Community Based Rehabilitation involves all community stakeholders in the rehabilitation of persons with disabilities especially the family of the person and include teachers, school principals, community nurse aids (CNAs), schools, the churches, NGOs, CBOs, FBOs and government departments. The interaction with different people in the community is critical to a disabled person’s development and wellbeing so they have to be trained and sensitized to provide the best socialization and accommodation for these persons.

Disability: Results from the interaction between persons with impairments (physical disabilities [e.g., cerebral palsy, spina bifida] visual impairment, hearing impairment) and attitudinal and environmen-tal barriers that hinders their full and effective participation in society on an equal basis with others.

Educational Assessment: An educational assessment is the formal process of collecting informa-tion about a student to be used in forming judgments and making decisions concerning that student. The major purpose of an educational assessment is to improve instruction to help the student learn.

Exceptional Learning Needs (ELN): Students with Exceptional Learning Needs are those students with or without disabilities who present more difficulties than other students of his/her age; they present special talents and to be given appropriate attention they need to be provided with support resources and modification and/or accommodations to one or various aspects of the school curricu-lum and to the educational facilities.

Inclusive education: Inclusive education is based on the affirmation of the same rights to equal edu-cation for every person to learn within his or her own community (NaRCIE).

Low Vision: is defined as the best corrected vision in the better eye of 20/80 – 10/200.

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Milestones: a set of skills that a child, within a given age range, should achieve.

Most Enabling Environment: The Most Enabling Environment in educating a child, according to NaRCIE, is to have them as close to the regular classroom setting as is feasible. “This principle recognizes that where it is not in the best interest of the child to be included in the class, he or she may need a different setting for the teaching-learning process. Both home-schooling and the maintenance of special schools and classes and resource rooms must, therefore, be considered in the plan of action” (NaRCIE Five Year Plan 2010-2015).

Special settings: Special settings refer to places other than the normal places children are educated including home, special education classes and special education centers.

aCronyms

BAPDA Belize Assembly of Persons with Diverse AbilitiesBCVI Belize Council for the Visual ImpairedCARE Community Agency for Rehabilitation and Education of Persons with DisabilitiesCBR Community Based RehabilitationCOMPAR Community ParentingCRC Convention on the Rights of the ChildCSN Children with Special NeedsECLAC Economic Commission for Latin America and the CaribbeanEFA Education for AllELN Educational Learning NeedsGOB Government of BelizeHFLE Health and Family Life Education IEP Individual Educational ProgramIRP Individual Rehabilitation ProgramITVET Institute for Technical/Vocational EducationMoE Ministry of EducationMoH Ministry of HealthNaRCIE National Resource Centre for Inclu sive EducationNCFC National Committee for Family and ChildrenNPA National Plan of ActionPACSN Parent Association for Children with Special NeedsPEC Primary Eye ClinicRFO Rehabilitation Field OfficerROP Retinopathy of PrematuritySitAn Situational AnalysisUNESCO United Nation Education, Scientific And Cultural OrganizationUNICEF United Nations Children’s FundWFFC World Fit for Children

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This situational analysis focuses on visual impair-ment, which was one of the types of disabilities discussed in the Situational Analysis of Children with Disabilities, completed in 2012. The number of visually impaired children is on the decline since 2007 when there was a spike of 14 cases of blind babies due to retinopathy of prematurity (ROP) registered that year. According to the Population and Housing Census of 2000, in 2000 sight was one of the highest incidences of disability among all children. Of all children with disabilities at that time, 26.4% had sight disability. This was more prevalent among females (29.8%) than among males (23.3%). The disability was least prevalent in Belize District (18.1%) and most common in Stann Creek (32.5%) and Cayo (31.3%) districts. The sta-tistics for the 2010 census are not yet available to determine the current status and to start looking for trends.

The Belize Council for the Visually Impaired (BCVI) is a non-government organization (NGO) with a major part of its mission dedicated to assisting children who are blind and visually impaired to achieve their full potential. CARE-Belize provides for children who are physically immobile. There are, however, no organizations that cater to the needs of children with disabilities other than blind-ness and physical mobility between zero and five years old. At five years, NaRCIE gives support to the teacher, school, and parents to provide an ac-cessible and conducive learning environment for children to enjoy their right to education. A major challenge for some of these children and their par-ents is that their families are poor, which makes it difficult for the children to get the medication, therapy, and training needed to optimally develop.

The government of Belize is promoting inclusion of children with disabilities in the school system. However, there is no evidence of systematic and sustained action to realize this goal except for

In 2000 children with visual impairments disability in Belize represented 0.7% of all children zero to eigh-teen and the disability was more common among girls (0.7%) than boys (0.6%). From unofficial num-bers, this percentage is on the decline. Similar in-formation is not yet available from the 2010 census. BCVI keeps excellent records of all children who are blind and visually impaired and is the only organi-zation that keeps records on these children. Its re-cords show that in 2000 the Stann Creek and Cayo districts had the highest percentage of children who are blind and visually impaired but in 2012 Belize and Cayo districts have the highest prevalence.

Children who are blind and visually impaired receive services from NaRCIE and BCVI, but most support comes from BCVI. In the Situational Analysis of Chil-dren with Disabilities, BCVI was described as “…one of the most active and impacting NGOs on the lives of children with disabilities in general and on the vi-sually impaired in particular. Because of its services, children who are blind and visually impaired are at-tending regular schools (p. 37).”

BCVI was founded by Mr. William Fonseca as a com-mittee of the Belize Red Cross in 1981 to provide ser-vices for people who are blind and visually impaired. It has grown to provide eye care (both primary and secondary eye care services) and rehabilitation ser-vices to children and adults throughout the country. It offers free eye examinations, and treatments and surgeries are provided at an affordable cost, lower than the cost of services in the private practice (Na-tional Eye Health Plan for Belize 2010-2014). Similar to the CARE Belize arrangement with the Ministry of Human Development to offer care to persons with disabilities, BCVI and Lions Club have an agree-ment since 1998 with the Ministry of Health to pro-vide ophthalmic services on its behalf. This is done through a National Eye Clinic (NEC) established by BCVI in Belize City and primary eye clinics (PEC) in Belize City, Orange Walk Town, Belmopan, Dangriga and Punta Gorda. Services are provided to people all over the country including remote villages.

BCVI has provided services that response to the needs of the community. In 1984 it hired its first RFO in Belize City. The period between 1988 and 1990 was very active for the organization. During this time a Book Production Unit for Braille and large-print texts was established, two RFO’s were added (Orange Walk and Cayo), primary eye care was expanded throughout the country, and a database of legally blind citizens was started. The Early Stimulation Programme was introduced and production of low-cost glasses started between 1991 and 1995. A second RFO was also hired for the Belize District during this period. Annual summer camp started and ophthalmic services introduced in the period 1996 to 2000. Since 2001 BCVI has been strengthening all it services. For example, it has introduced speech software and computers coun-trywide for students who are visually impaired. According to its Annual Report for 2010, BCVI held 801 clinics, of which 79 were outreach clinics to the most remote villages in the country. In these PEC clinics 11,104 persons were seen and examined by their optometrists; of that, 19.2 percent (n=2129) were children. Patients with a low visual acuity are referred from the clinics to the rehabilitation depart-ment for assessment, although not all need rehabil-itation. In 2010, 170 persons received rehabilitation services, with children being priority.

Most of the rehabilitation services provided by BCVI are done through their four RFOs (1. Corozal/Or-ange Walk (North), 2. Belize/Cayo (Central), 3. Stann Creek, and 4. Toledo) using the CBR approach. These services are complemented by others provided itin-erant resource teachers (IROs), classroom teachers, parents, and volunteers. According to Mrs. Musa, Executive Director, volunteer optometrists come from the United States from time to time to provide services to the underserved areas of the country. BCVI also works with the business community to identify job opportunities for the visually impaired.

BCVI is using its database to understand the causes and evolution of blindness and visual impairment in Belize. It is currently examining the increasing number of children with retinopathy of prematurity (ROP) and is working along with the Neonatal Unit of KHMH to implement strategies to reduce the inci-dence of ROP. According to the National Eye Health Plan 2010-2014, there is no national screening pro-gram and the exact number of newborn babies with ROP is unknown. One of the four strategic direc-

some efforts by NaRCIE to train resource teachers. The following statement in the Situational Analy-sis of Children with Special Needs 2012 points to the direction that needs to be charted. “Govern-ment needs to consider children with disabilities in planning for education programs, construction of new school building, and building the capacity of teachers to confront the challenges of children with disabilities. To do that however, entails that persons with disabilities themselves take a leading role in the process of inclusion, as experts on the way in which they want society to treat them. This means that people with disabilities must be presented with the same opportunities as other members of society in decisions on all policies, ac-tions, and plans that concern them” (p. 7).

This study validates the perception that children who are blind and visually impaired, without any other disability, are fully included in school. It also shows that these children are not discriminated against and not excluded from participating in rec-reational activities. They are also caringly helped a lot by their teachers, classmates, members of their community, friends, and family members.

1 2BACKGROUNDINTRODUCTION

Visually impaired child

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tions of the National Eye Health Plan 2010-2014 is the “Reduction of blindness and visual impairment in children.”

There are some major milestones for BVCI in pre-venting blindness, maintaining sight, and rehabili-tating persons with impaired or loss of vision. Its database is now a part of the Belize Health Infor-mation System (BHIS), which helps to track children and others through the health system and to provide better and more effective services for them. Anoth-er milestone is a National Eye Health Plan for Belize 2010-2014 that brought together the views and ex-perience of all stakeholders. BCVI is also participat-ing in VISION 2020, a global initiative to eliminate avoidable blindness by the year 2020 and reduce the prevalence of preventable or curable blindness.

One other NGO that assists children with visual impairments is the World Pediatric Project. The World Pediatric Project has been assisting children in need of ophthalmic surgeries which they other-wise would not have benefited from due to the high costs. These surgeries are typically offered by spe-cialists who visit the country annually. Over the last ten years, one ophthalmic surgery was conducted abroad.

Sightsavers International supports the work of BCVI, however funding from this organization is dwindling. “Sightsavers is an international nonprof-it working in some of the poorest countries in the world to restore the sight of blind people, provide medical care to prevent blindness, and promote equality of opportunity for disabled people” (Sight-savers International Website). There are also other organizations that work with children with special needs from which children who are blind and visually impaired also benefit. These organizations collaborate with BCVI, NaRCIE, Stella Maris, and other organizations. They include the Office of the Special Envoy for Women and Children and Belize Special Olympics. There are also parent support organizations in Orange Walk Town (PASPNOW), Belize City (PACSN), and Dan-griga (SCAP). In addition, parent teacher associa-tions (PTAs) of schools such as St. Joseph Primary School in Belize City also support children who are blind and visually impaired.

The purpose of this Situational Analysis is to de-termine the situation of blind and visually im-paired children in Belize, with a focus on children in schools. More specifically the study is to:

• Develop a deeper understanding of the situa-tion of girls and boys ages 0-18 years through demographic and socio-economic trend anal-ysis and the testimony and judgment of chil-dren, adolescents, and professional practitio-ners;

• Contribute to the generation of evidence-based knowledge and identification of criti-cal information gaps that stimulate dialogue on, and serve as a basis for, rights-based and child-centered/sensitive policy making;

• Contribute to UNICEF’s commitment to de-velop national capacity in general and re-search capacity on children, in particular those with special needs and disabilities living in south-side Belize City and Toledo;

• Identify and document model practices in the area of inclusive education, and to high-light the mechanisms and strategies that have proven effective, the areas of concern and the constraints in successfully mainstreaming children who are blind and visually impaired; and

• Provide recommendations for the develop-ment of specific strategies for future interven-tions.

Two scoping meetings with BCVI leaders were conducted to clarify objectives of the consul-tancy, to agree on methodology, and to establish a timeline. A comprehensive review of all BCVI an-nual reports over the last ten years was conducted to contextualize the historical work of BCVI and ef-forts to help visually impaired children to live nor-mal lives. In the Situational Analysis of Children with Special Needs (2012) a comparative analysis of UN conventions, legislations, policy, and na-tional plans was conducted to succinctly describe the legal framework in which children with special needs exists. Highlights from that report pertain-ing to children with visual impairments are report-ed here. The homes and schools of children who are blind and visually impaired were visited to get a compre-hensive picture of the trajectory and environment of these children. The author visited preschools (n = 10) and primary schools (n = 25) where visually impaired students are enrolled and interviewed the visually impaired children, their teachers, their principals and some of their classmates (see Table 1 and Appendix B). Six children who will be starting preschool in September 2012 were also visited. All visits were made along with the responsible RFO, and permission was obtained from the principals

to visit the visually impaired student’s classroom.

We also visited the homes of six children with visu-al impairments living in rural and urban areas who will not be attending school until September 2012. The mother was usually the parent interviewed but in a few cases it was both parents, or the grand-mother and in two cases it was the single-parent father. Other family members of the children who were around at the time of the home visit were also briefly interviewed.

The Executive Director of BCVI, NaRCIE’s manager and CARE Belize’s Director were interviewed to get detailed information about the services their orga-nizations offer. To further understand the situation of children who are blind and visually impaired in their locality, in- depth interviews were conducted with NARCIE’s IRO who is responsible for the blind and visually impaired, and the most senior CARE RFO. All four of BCVI’s RFO, along with the Reha-bilitation Coordinator, were interviewed and they facilitated the visits and interviews with their cli-ents.

All annual reports for BCVI for the last ten years were reviewed and information gleaned was used to inform the analysis of the data collected, sub-stantiate findings and validate the recommenda-tions made herein. An online search for documents and literature related to children who are blind and visually impaired yielded several relevant and use-ful references including one about the HadleySchool for the Blind.

Table 1: Students visited by Level and District

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The early introduction of rehabili-tation and education services con-tributes greatly to a higher level of achievement. (BCVI Annual Report 2010)

There is no organization in Belize that is respon-sible for all persons with disabilities. So when a child is born blind or with other disabilities, assis-tance is sought from organizations that provide services related to the child’s disabilities. A visu-ally impaired child can be introduced to BCVI by a doctor, a nurse, and/or a parent. The child is then reviewed by one of BCVI’s ophthalmologists to determine if he or she could benefit from treat-ment or is diagnosed as irrevocably blind and needs rehabilitation. If the child needs rehabili-tation he/she becomes a client of BCVI who works with the person until his/her ultimate milestone is achieved.

5.1 EDUCATION

The population of children who are blind and visually impaired in Belize is distributed throughout the country and is comprised of an approximately equal number of boys and girls. These children display varying adaptations to vi-sion loss. With regard to degree of vision, the stu-

dent population includes persons who are totally blind or persons with minimal light perception, as well as persons with varying degrees of low vision. For some individuals, blindness or visual impairment is their only disability, while for others, blindness or vision impairment is one of several identified disabilities that affects, to vary-ing degrees, learning and social integration. For example, some children who are blind or visually impaired also have hearing, orthopedic, emotion-al, or cognitive disabilities.

The US Department of Education recognized the following:

Primary school age children who are visu-ally impaired with no other disability are all attending mainstream schools and do not need special settings (home, special education class, and special education center). These children all said they like going to school. According to their teachers these children are doing well academi-cally for their age. For example, Rowan Garel (14 years) and Arminda Uc (12 years) will be going to high school in the 2012-2013 school year. Accord-ing to principals and teachers, children who are blind are not discriminated against at school. The

Disabled child with mother

author observed that their classmates voluntarily assist and facilitate children who are blind and vi-sually impaired and children with other disabili-ties inside and outside the classroom.

5.1.1 Zero to Younger than Three

Children who are born blind or with low vision are referred to BCVI by their parents, doctor, or nurse. These children are registered with BCVI and their information becomes a part of the organization’s registry. BCVI immediately starts to provide earlystimulation using the CBR approach until they arethree years old. This support involves training and guiding the parents, other family members, and members of the community to help the child reach the milestones appropriate for a child giv-en his disabilities and age. These are outlined in handouts, which each family receives. In some cases, children and families are given stimulation materials such as toys and eyeglasses. When a family is poor, RFOs work with Belize Red Cross, Department of Social Services, and others to get pampers, food, clothes, and medications to sup-port these families.

5.1.2 Three to Under Five

At three years old, visually impaired children start preschool, except in cases when they also have other disabilities. In many cases BCVI’s RFOs proactively assist parents to get placements for their children who are blind and visually im-paired in preschool. Currently all visually im-paired children known to BCVI with no other dis-ability are enrolled in preschool. At preschool BCVI provides orientation and mobility so that children can find their way around the school en-vironment and can interact with other students with reduced limitations.

For example, they are taught how to find the bath-room, the playground, their way around the class-room, and a sibling or relative in the school. In some cases, BCVI continues early stimulation and pre-Braille skills with these children. Three and

four year old children who are blind and visually impaired attend summer camp to continue ear-ly stimulation, develop orientation and mobility skills, and prepare them to enter primary school.

BCVI also provides children with a cane and Braille materials and provides training on how to use these. BCVI works with preschool teachers to give them ideas on how to teach the alphabet in Braille, how to color, and how to do other activi-ties. BCVI also provides children with a Braille machine and Braille paper to use at school, and training in Braille for teachers. NaRCIE’s current interaction at this level with students who are blind and visually impaired is very limited but ac-cording to its manager the department should be working with schools to determine and address the assistance teachers need and to get familiar with children. This acquaintance would help to fa-cilitate the working together of the child and the IRO when the child starts primary school. NaRCIE should also assess these children to determine their intellectual capacity so that their teacher can provide activities appropriate for them. Accord-ing to the Director of CARE Belize, in cases where a child is blind or visually impaired and also has a physical disability, the organization provides ther-apy, modified classroom furniture, and mobility equipment such as a wheelchair. A student in ru-ral Corozal was observed with a wheelchair from CARE Belize.

“In addition, persons with similar degrees of vision loss may function very differently. A sig-nificant visual deficit that could pose formidable obstacles for some children may pose far less for-midable obstacles for others. This is because ad-aptations to vision loss are shaped by individual factors, such as availability and type of family support and degree of intellectual, emotional, physical, and motor functioning. Therefore, in addition to the nature and extent of vision loss, a variety of factors needs to be considered in de-signing an appropriate educational program for a blind or visually impaired child, and these fac-tors could change over time.”

5 VISUALLY IMPAIRED CHILD (0-7)

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i) the principal of Hummingbird Primary School (Belize City) fighting for more time for Rowan to sit the PSE (2012),

ii) the principal of St. Peter’s Primary School (Or-ange Walk Town) fighting for Arminda to use her talking calculator to sit the PSE (2012), iii) principal/manager of Preschool working with her community and church group to get teaching aids and ideas for her blind student, and iv) the principal of St. Joseph who bought a Braille machine for a blind student to use at school.

All the teachers interviewed and observed, (ex-cept for one - St. Joseph), demonstrated a high level of interest in educating the child who is blind and visually impaired. Teachers were observed to bond well with the students who are blind and visually impaired. The only exception was with one student at Pickstock Community Pre-school in Belize City where the student did not co-operate with the teachers in completing her work, despite great effort by the teachers. A teacher at St. Peter Claver in Punta Gorda, admits that she knows Braille but not enough to help her student reach his full potential. This student is rated as above average. The teacher expressed her will-ingness to learn whatever is needed to help this student and her desire to move with the student to the next class so that she can continue to work with him. The author heard of a case in which a teacher on internship did not want to have a blind child in her class because she felt that would threaten her successful completion of the intern-ship. This seems to have been an isolated case.

Specialist carrying out eye checkup

5.1.3 Five to Fourteen

5.1.3.1 schooling

The goal of NaRCIE is to ensure equity and rel-evant educational opportunities for children with special needs. When a child, who is blind or visu-ally impaired, reaches primary school, NaRCIE is to ensure that an environment conducive to learning is provided to the child to maximally develop his intellectual potential. It should also help with the preparation of school materials, to train teachers in methodology to teach children who are blind and visually impaired, and to follow up with teachers to monitor the student’s progress and offer continued support to the teacher. Students get one or two vis-its for the school year from an IRO. On a scale of one to ten with ten being the highest, the IRO’s provi-sion of these services can be rated below two be-cause more than half of the students are not getting the minimum service from their IRO. An obvious example of under-service is that of three students (one at Holy Ghost Primary School and one at Naza-rene Bright Star Preschool, both in Dangriga) who needed assessments at the beginning of the school year and to-date have not yet received it, although the school year was three weeks from the end at the time of the author’s visit to the school. For these two children this means that their teacher did not have background information on them to design and implement the most effective methods to teach them. There is also a low vision student in Silk Grass Village who needs an assessment, and the teacher believes this person needs glasses. Four blind and visually impaired children in Belize were going to NaRCIE every week to get help with their school work, a service available to Belize City residents be-cause the IRO responsible for the blind and visually

impaired is located in Belize City. This service is not available to children in other parts of the country.

The Ministry of Education promotes inclusion of special needs children but this policy needs to be operationalized through NaRCIE. Except for trained teachers who took an introductory course in special education at UB or participated in BCVI training, most teachers are not trained to teach these children. The eight-year veteran IRO at NaRCIE with the port-folio for blind and visually impaired children had no formal teacher or education for the blind training. This IRO is BCVI trained and has completed all lev-els of training of Braille from The Hadley School for the Blind and is doing part one of the abacus course on her own volition and at her cost. The manager of NaRCIE is formally trained in education of the blind and visual impaired. However, the other IROs de-pended on the IRO with the portfolio for blind and visual impaired for training and support.

At the primary school level of education BCVI’s role is to provide orientation and mobility for students who are blind and visually impaired and to train teachers to use the Braille, abacus, and Cubarithm. It offers training to teachers at least once per year during the summer and at camps (summer, Janu-ary, and Easter). The strategy is for principals to identify the teacher who will be teaching the stu-dent who is blind or visually impaired so that the teacher can be trained during the summer in prep-aration for the new school year. However, this is happening for less than half of the children because the new teachers of these children are not identified early enough for BCVI to include them in a summer training session. The Manager of NaRCIE said that it is NaRCIE’s responsibility to ensure that prin-cipals identify these teachers. The training is held at a strategic location in the country to minimize the travelling or relocation of the teachers. For ex-ample, a training workshop is scheduled in PG for teachers in Toledo District and one in Orange Walk Town for teachers from Corozal and Orange Walk Districts. For the 2012-2013 school year, according to the Rehabilitation Coordinator of BCVI, all teach-ers of students who are blind and visually impaired in primary schools will be trained during the sum-mer of 2012. In some schools the entire staff will be trained. Orange Walk Technical High School and St. Joseph Primary School in Belize City are two such schools.

The goal of BCVI is to guide and facilitate the attain-ment of the developmental target given the child’s age and potential. Once the target for a child is achieved, visits to the child’s school and home are reduced to a minimum and are made to monitor progress. BCVI’s RFOs in many cases offer teach-ers ideas on how to teach different concepts be-cause follow up visits from NaRCIE are seldom. The quality of this coaching would be much better if the RFOs had some teacher training qualification or teaching experience. However, they do their best which is very helpful and welcomed by teach-ers. The author experienced this when an RFO of-fered ideas to a teacher with a master’s degree in education on how to teach a blind child to color. The teacher was happy that she got this new idea.

Students’ textbooks are transcribed to Braille by BCVI, which is a major enabling tool for children to develop intellectually. For a couple children, one in Corozal Town (Courtney) and one in Orange Walk (Dayell) this school year, their textbooks were not in Braille. All children who are physically and intellectually able to use Braille had a Braille ma-chine and Braille paper; and most of them were using it to the fullest with the exception of three. In the case of the child in Red Bank Village in Toledo District, the teacher knows enough Braille to help the child but the parents do not. The two teach-ers at St. John’s Vianney and St. Joseph primary schools in Belize City don’t know Braille, but the parents do. School principals and teachers play an important role in ensuring that children who are blind and visually impaired rights to education are fulfilled. All the principals interviewed embrace the pres-ence of the blind and visually impaired child in their school and many of them have demonstrated extra effort to accommodate these children. A limitation of some principals, especially of the smaller schools where the staff might have major changes in personnel, is their ability to identify the teacher who will teach the student who is blind or visually impaired the following school year early enough for the designated teacher to be included in BCVI’s summer training. Principals also encour-age teachers to contact their IRO when needed to express their needs. Four exemplary cases of the school principal advocating for the blind and visually impaired are:

Child with disability reading

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Challenges

1. A challenge observed in the classroom, especially in the middle and upper divisions of the primary school, is how educators of children who are blind and visually impaired teach skills that sighted children typically acquire through vision.2. Children used a variety of ways to read, write and do mathematics. For example, to learn to read children mainly used Braille but, in some cases, this was not possible be cause the teacher did not know Braille.3. In a couple of cases the students didn’t have their textbooks in Braille.4. The Ministry of Education does not have any defined system that operationalizes inclusion of children who are blind and visually impaired and children with other disabilities in schools.5. NaRCIE’s support for blind and visually impaired students is very limited.6. Girls absent from school during menstruation, with their parents’ approval, as they do not want them in school.

The other partner working toward the development of the child is the parent. Parents are generally fully supportive of their children being in school except, for a few. Five such cases were observed. The parents (mother and father) of a daughter in Or-ange Walk want their daughter out of school. The mother of a preschool student in Santa Elena, Cayo is contemplating taking her daughter out of school claiming that her daughter is not really learning be-cause the teachers are not effectively teaching her. The father of a thirteen-year-old girl in San Pedro Columbia, Toledo does not want her in school but the mother wants her to stay. In the Mayan culture the father makes the decisions for the family, but in this case, the child remains in school because the teacher insists that they send the child to school because it is the law. According to the principal, the day after this student turns fourteen she will be taken out of school. The mother (a single parent) of a seven-year-old student in Silk Grass Village is not involved with her child’s education. She has not visited the school for the entire school year, not even for her child’s report card even though the teacher has sent several messages inviting her to visit. The parents of a thirteen-year-old female student in San Miguel Village Toledo do not support her being in school and this student is expected to be taken out of school upon turning fourteen.

Parents receive training from both NaRCIE and BCVI, but most comes from BCVI, which provides training to use and operate the Braille machine. Al-most all of the parents have participated in one or

more of BCVI’s summer camps. These camps seem to be an exciting time for both children and parents. The author visited a rural home (Georgetown, Stann Creek district) in early June and the child was al-ready packed to go to camp, which starts on July 16. A grandparent who is now the child’s legal guard-ian has been to all the camps and does whatever it takes for her granddaughter to get the best educa-tion. During the field visits there was no evidence of NaRCIE’s interaction with parents. In the case of St. Peter’s Primary School in Orange Walk Town there is a functional parent support group for students of the special education center, and the parents of the three children with visual disabilities are active members (Victor, Arminda, and Dayell).

5.1.3.2 Pse and bJaT examinations

Students who are blind and visually impaired are accommodated to sit the BJATS and the PSE and those who successfully complete primary school go on to attend high school. To sit the BJATS, students get assistance from the school as it deems neces-sary. According to Ms. Martinez, Director of Sup-port Services in the Ministry of Education, students are given an additional thirty minutes and a reader to sit each paper of the PSE. Three students took the 2012 PSE: Rowan (Belize City), Arminda (Orange Walk Town), and Lloyd (Dangriga). Rowan will be going to Belize High School and Arminda will be go-ing to Orange Walk Technical College. It is not yet known if Lloyd is going to high school. Noteworthy is that Rowan’s score on the PSE this year was 93%.

A blind or visually impaired individual’s ability to move around independently is closely linked to the individ-ual’s self esteem. (US Depart-ment of Education, 2000)

5.1.4 Fifteen to Under Eighteen

One child between 15 and 17 years was visited, and she was out of school and not working. This person did not say a word to the author nor the RFO when we visited her in Cristo Rey, because, according to her sister who was at home when we visited, she simply doesn’t like to speak.

One young man (19 years) who is graduating from high school in Dangriga was interviewed. He is ex-pecting to go on to sixth form. He is very articulate and ambitious. The teachers and principal of his school try their best to create the most conducive learning environment for him.

5.1.5 Training Camps

Since 1996 BCVI has been offering summer camps as an important activity to help develop the po-tential of children who are blind and visually im-paired. It is a time when students work on their weaknesses and deficiencies so that when they start their new classes they will be on par with their classmates. It also gives them an opportunity to have fun and interact with others with similar disabilities. On average, 30 children who are blind and visually impaired attend the camp each year. Some of these are children with multiple disabilities that need personal assistance. They attend with a parent or guardian. Teachers are also invited to the camp to learn strategies that they can use in their classroom, as well as to assist with the operation of the camp.

BCVI has recognized the need for more assistance for primary school children and has expanded its

services to include a three-day New Year and a four-day Easter camp. These camps started in 2012 and each catered for 12 primary, secondary and tertiary students. These camps, like the summer one, offer refresher courses in Braille, math and computers to help them keep up with other students and meet their developmental milestones. Based on where a child is in school the RFO develops an IEP and an IRP to accomplish at camp.

To offer these camps, BCVI has to aggressively fun-draise because donor contributions are continu-ously being reduced. An intelligent and active blind primary school student who highly valued these camps conducted a climb up Victoria Peak last year and this year will be doing a walk across the coun-try to raise funds for the camps. These fund raisers have been successful in keeping the camps going and raising awareness of BCVI’s activities.

5.1.6 Volunteers

From time to time BCVI gets student volunteers from St. John’s College High School doing com-munity work to help with scanning and editing of textbooks. Some support also comes from other community members who help with the scanning and editing of textbooks.

5.2 TRAINING FOR SERVICE PROVIDERS

5.2.1 Teacher Training

Some teachers get training from NaRCIE and BCVI. NaRCIE’s goal is to provide training for teachers, especially during the summer. How-ever, according to the IRO responsible for chil-dren who are visually impaired, this is not fully happening because teachers are not assigned to their classes in time for them to attend the neces-sary training. NaRCIE’s new strategy is to have a school inclusion coordinator (SIC) who acts as a resource person in a school to offer assistance to teachers, children, and parents. In August 2012 there will be a second one-week workshop in each district to train these coordinators. According to TEDS Director teachers can earn Continued Professional Development (CPD) credits for these workshops.

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BCVI offers short-term training, ranging between half a day to a day and a half each year to teach-ers of students who are blind and visually impaired. This year, according to the Rehabilitation Coordina-tor, all teachers of preschool, primary school, and high school will be trained for the new school year. For some schools the entire staff will be trained, as is the case of Belize High School, Orange Walk Tech-nical High School, and St. Joseph and St. John’s Vi-anney primary schools. In a few cases, teachers also attend summer camps where children work at de-veloping their skills to meet their milestones. Teach-ers get an opportunity to familiarize themselves with the children they will teach next school year, and to develop their pedagogical skills relevant to these special needs children.

5.2.2 NaRCIE IRO Training

A major limitation of NaRCIE’s IROs is that they do not know how to read or write in Braille, they do not each have a Braille machine and the department does not have one. The only IRO that can use Braille machines is located in Belize City with the portfolio for visually impaired children. The other IROs are trained by this person. A six-month training pro-gram is currently being conducted for all IROs by this IRO. The sessions are done in a pragmatic and meaningful way. When they come to Belize City for their monthly staff meetings they stay an extra day to attend a training session. According to the Di-rector of Teacher Education Development Service (TEDS), IROs can apply for credit for these trainings, which makes the training attractive to pursue. The manager of NaRCIE is trained to teach students who are blind and visually impaired but was not involved with the training of IROs. IROs also get some train-ing from BCVI upon request.

5.2.3 BCVI RFO Training

Training for BCVI’s RFOs is done on a regular basis (at least once a month) with financial support from UNICEF. The most typical training is for three to four days and covers a variety of topics. See agenda for a recent training offered in Appendix C. A parent of a blind child from the Toledo district attended the last training. The author attended the last day of this session. The BCVI retired-rehired Rehabilitation Co-ordinator, who is very experienced and highly com-

petent, is responsible for all training for RFOs. RFOs are also required to continuously complete online courses from the Hadley School for the Blind in or-der to develop professionally. For example, the two RFOs who are with the organization for around six months or less are working on Braille One until ap-proximately September. The mission of The Hadley School for the Blind is “to promote independent liv-ing through lifelong, distance education programs for individuals who are blind or visually impaired, their families and blindness service providers.”

5.3 HEALTH

Children with visual impairment access health services similar to normal children. These chil-dren also receive eye examinations through BCVI and those with other unknown forms of disabilities like autism, attention deficit disorder (ADD), and attention deficit hyperactivity disorder (ADHD) are tested and treated by visiting doctors free of cost. In cases where children are blind and physically dis-abled, CARE Belize facilitates therapy and mobility equipment from zero to six years also using the CBR approach. In cases where children have visual and other disabilities, there is no protocol to determine the role of BCVI, CARE Belize, and NaRCIE, which occasionally leads to deprivation and duplication of services. There is also no lead entity that recognizes the condition of the disabled child and works to en-sure that his rights are upheld. Currently, there are seven students with visual and other disabilities. These students are Carvajal, Ryan, and Udelio (Be-lize City), Marie (Chunox), Milton and Lloyd (Dan-griga) and Joshua (Belmopan). Joshua needs to be assessed by NaRCIE. Dr. Marjorie Parks, Deputy

Box 1: The Challenges of Jiyah Thomas

Jiyah Thomas, a happy and joyful little girl, was born on December 7th, 2006 and lived in the Kings Park with her mother and her siblings.

BCVI has been working with the child from the tender age of one year two months. Visits were made on a weekly basis to ensure that the child reached her milestones based on the skills in the Oregon project, which included social, fine motor, gross motor, language, self help, and cognitive skills.

These were taught to the mother and caregiver through Individualized Rehab Plans provided by the BCVI RFO. Between the ages of two and three was a bit challenging. Preparing the child for pre-school at age three was the goal. Unfortunately that didn’t materialize because there were some obstacles that needed to be overcome first. Therewas a lack of support from the parent and caregiv-er, but despite these challenges Jiyah has reached many of the goals set out for her.

At age 4, Jiyah had attended a two-week summer camp held by BCVI. The objective of the camp was to evaluate the child and have a RFO work with her on a one-on- one basis. Helping her to socialize with other children also prepared her for attending preschool. Jiyah is presently attend-ing Bethany Preschool where she is doing excel-lent despite all the challenges that she has been through. Her skills have developed over time. A weekly visit is made by the RFO to ensure that she is acquiring the skills laid out in the preschool curriculum. Basic Braille was taught to the princi-pal so it can be taught to Jiyah. She was provid-ed with a Braille machine and Braille paper from BCVI so that she could work independently like the other students. Mrs. Lewis sits besides Jiyah and has her practicing her alphabets. She also interacts and is involved in whatever activities are being done at school. Jiyah has successfully completed preschool and will attend St. Joseph Primary school in the new school year (2012-13).

Jiyah has received abundant love and care from family members, teachers, friends, and school. She is very inquisitive in her surroundings. She will continue to attend the summer camps and receive the support from BCVI.

Director of Health Services (Nursing) said no special service is provided to children who are blind and visually impaired by the Ministry of Health.

BCVI offers outreach clinics to underserved areas of the country through the voluntary service of several groups of optometrists from the United States each year. Children in Southern Belize (Stann Creek and Toledo) and Southside Belize City receive free glass-es through National Health Insurance (NHI). All chil-dren have access to BCVI’s five PEC Clinics where the examination and refraction are conducted by an optometrist at no charge. Low cost glasses are available based on need, with special consideration given for those unable to meet the cost.

Learning in an enhanced classroom Special needs child

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Box 2: The Story of Jane Doe

Jane (11 years) was born a premature baby. She was delivered at KHMH and had to be admitted for two weeks due to her early delivery. Her grand-mother went to give a helping hand and has been the primary caretaker since then. The mother had noticed she had a problem with her vision and did not want anything to do with her, so she ended up with her grandmother.

Ms. Jones is Jane’s paternal grandmother but treats Jane as though she is her own child. She ensured that Jane received a preschool education and continues to attended BCVI’s summer camps in Belize City to ensure that she can effectively play her role in her granddaughter’s development.Thanks to Ms. Jones’s dedication, her grand-daughter has excelled in school.

BCVI has provided her with her Braille machine and Braille paper and other tools to help her in her daily living skills. Presently she has gotten her own Braille machine from the Minister of Health. BCVI also transcribes her textbooks into Braille each year.

BCVI has provided teacher training at the teachers’ request and when the grandmother sees a need. The grandmother is knowledgeable in Braille and at times even helps the teachers. When there is a problem at school the grandmother calls the IRO from NaRCIE who is helpful but does not know Braille well enough. The grandmother expected that the IRO from NaRCIE responsible for the blind and visually impaired located in Belize City would have visited the school this school year, which is almost finished, to work with the class teacher. The grandmother found a person to help Jane with the abacus so she improved her math skills.

Jane will be going into standard four in August of 2012, and the person who will be teaching her has been invited to be a part of the summer camp this year. Overall, Jane is very bright - and has a prom-ising future thank to her grandmother, BCVI and those who support her.

5.4 OVERVIEW OF THE CHILDREN WHO ARE BLIND AND VISUALLY IMPAIRED

The blind and visually impaired children in Belize are generally healthy children at different socio-economic levels with the majority belonging to poor families. These children can be observed playing with other children in school playgrounds. The author observed a blind child riding her bicy-cle and heard of other children who are blind do-ing likewise.

Some students who are blind and visually impaired perform above average in their classes while some are far below average. In some cases children are in one class but are doing work at a far lower level. For example, a child in rural Toledo is in standard four but she is given class work equivalent to that of an infant one student. The author attributes this low level of intellectual development mainly to the lack of support they get from their parents. On the other hand, parents of children, e.g., Rowan, Courtney, Maria, Dylan, and Juan who perform at above average in school, are very supportive of their child and school.

The author concluded that two of the children’s homes visited were indigent and many were poor based on the type and condition of their homes and the furniture and appliances in the homes. The state of poverty of these families makes it difficult for the families to provide a healthy environment for their children.

According to the manager of NaRCIE, IROs will re-port on each client who is blind and visually im-paired at the end of June 2012. This will be a good enabling tool to facilitate monitoring and evalua-tion of children once it is maintained and the infor-mation is shared among all stakeholders.

It is evident that without BCVI’s rehabilitation ser-vices, children who are blind and visually impaired would not be living the healthy and normal lives they are enjoying, nor would they be doing as well as they are doing in school. Most of these children would not be able to read and write.

In Belize there are currently 116 children known to BCVI with visual impairments ranging from hav-ing low vision to being blind. Approximately half of these children (n =57, 49%) are blind, a little more than a quarter have low vision (n = 32, 28%), and the others (n = 27, 23.3%) are either blind or low vi-sion, and have at least one other type of disability (see Table 2 and Figure 6). These children appear not to be proportionately distributed across the six districts but the exact proportion by district could not be determined because the number of children by district from the 2010 population census was not available from the Statistical Institute of Belize (SIB).

The causes of visual impairment of these children are mainly due to ROP (33%) and other causes (69%). Glaucoma and cataracts are responsible for only 3 and 4 percent, respectively, of blindness among children (see Table 3). In 2010, 34 children were registered with ROP so BCVI “… made plans to work with the neonatal unit at the main hospital to put in place strategies to reduce the incidence of ROP” (BCVI Annual Report, p. 10).

Visual impairment is more prevalent in rural than urban areas (see Table 4). The question is whether or not this is due to the lack of access to health care in the rural areas. Corozal, Cayo, and Toledo districts show large differences between the number of rural and urban cases of visual impair-ments. For the other districts, there is either no difference or the difference is one. This information can be used to help design interventions aimed at reducing visual impairment.

Fifty-one (85%) of the approximate 60 school aged children with visual impairment in Belize are in reg-ular school. The children who are not in school are the ones with multiple disabilities, such as speak-ing, physical, hearing, and learning. One such child is attending Stella Maris School, and is the only per-son with visual impairment at this school.

The only NGO that supports children and adults who are blind and visually impaired in Belize is BCVI. The service of this organization has grown over the last ten years but its services to children are threatened because external and local fund-ing is becoming scare. When a child who is blind or visually impaired also has other disabilities, it is expected that CARE Belize will assist this per-son. This organization, however, does not current-ly have a RFO in the Cayo District. The RFOs do not have a vehicle to visit their clients, and there are no systematic and regular visits to clients, es-pecially those in the rural areas. All of these are financially related limitations, which prevent the organization from providing the minimum service to its clients.

One of CARE Belize’s goals is to enhance the mo-bility of children by facilitating therapy and the ac-quisition of mobility equipment. In some cases where children are both visually and physically disabled BCVI and CARE Belize teamed up in the past to work with these children, especially in the Cayo district. This practice is currently not evident but needs to be the modus operandi throughout the country. If these organizations work together and pool their resources, they could maximize the quality of service children with multiple disabili-ties receive. It is important that CARE sustainably achieve its goals before collaboration with BCVI could be mutually beneficial to both organizations.

6 7PREVALENCE OF BLIND-NESS AND VISUAL IM-PAIRMENT IN CHILDREN IN BELIzE

NGOs AND CBOs THAT SUPPORT CHILDREN WHO ARE BLIND AND VISUALLY IMPAIRED

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Table 3: Causes of visual disabilities among children

Table 4: Children who are blind and visually impaired by district and area

Blind49%

Low Vision withOther Unknown

Disabilities3%

Blind with OtherUnknown Disabilities

17%

Blind with PhysicalDisabilities

3%

Low Vision28%

Table 2: Number of children with different types of visual impairments

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Young (2012) found the following regarding child protection.

“The Ministry of Human Services does not pro-vide any services specifically for children with dis-abilities (Ava Pennil, Director Human Services). . .However, the NCFC that falls under the portfolio of the Ministry of Human Services is responsible for the NPA 2004-2015. The NPA has several tar-gets related to disabilities. Three of them are (i) to reduce the incidence of disabilities in newborns caused by prenatal complications, (ii) to increase the detection, diagnosis, and treatment of children with disabilities, and (iii) to ensure that all children with disabilities have access to relevant education, with at least 60 percent enrollment with the regular school system” (p. 44). He also noted the following.

“NCFC is not an implementing agent but it moni-tors and evaluates the achievement of the Plan. In the 2010 evaluation of the Plan none of the targets for disabilities were evaluated because there were no data but targets indirectly related to disabilities were evaluated. For example, the target to reduce the incidence of low birth weight (less than 2.5 Kg.) to 3.7% of all births increased from 3.3% in 2003 to 8.8% in 2009 (NCFC 2010)”(p. 44).

The Director of NCFC was asked what can be done to improve access to preschool and primary school for children who are blind and visually impaired. She reiterated the need to have one entity that is responsible for the disabled to streamline efforts to work for children and persons with disabilities. She also believed that BCVI and NaRCIE could strengthen their collaboration to help children with visual impairment.

Children who are blind and visually impaired are protected by law under the Families and Children Act 173 of 2000. This law requires that authorities take appropriate steps to see that early assess-ments are conducted and that children with dis-abilities have equal opportunities to education. It asserts that “The State shall take appropriate steps to ensure that children with disabilities are afforded equal opportunities to education” (p. 20). Part II-8 of the Act states that authorities:

The Ministry of Education has an inclusion poli-cy. Children who are blind and visually impaired are fully included in primary education but the wherewithal to effectively educate these children is not adequately available across schools and districts. For example, most teachers of children who are blind and visually impaired have little skill to teach these special needs children. NaRCIE expects that the School Inclusion Coordinators (SIC) will help to alleviate this prob-lem by working with teachers in their schools who have students with special needs. However, ac-cording to reports on disability, there is an implic-it assumption that each “type of disability” has

Table 5: Number of children who are blind and visually impaired by level of education

ChildProtection LEGISLATION8 9

Table 6: Children who are blind and visually impaired in school by district and area

Two older students are attending the University College of Belize - one at the Bachelor’s level and the other at the Associate’s level - Belmopan and Punta Gorda.

shall take appropriate steps to see that those children are (1): (a) assessed as early as possible as to the extent and na-ture of their disabilities and (b) offered appropriate treatment. (2) The State shall take appropriate steps to ensure that chil-dren with disabilities are afforded equal opportunities to education.

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specific health, educational, rehabilitation, social, and support needs. This suggests that the SICs will have to be trained in methodologies to address the different disabilities and individual differences of students.

Belize has signed onto several international dec-larations and conventions protecting the rights of children who are blind and visually impaired. These include the Convention on the Right of the Child (CRC) (see Box 3 for an except), The Con-vention of the Rights of Persons with Disabilities (CRPD), World Fit for Children (WFC) and oth-ers shown in Table 7. These international agree-ments are reflected in national laws, policies and plans so that all children can enjoy equal human rights. They are embedded in the National Plan of Action 2004-2015, the Education Act, the Fami-lies and Children Act 173 of 2000, National Eye Health Plan for Belize 2010-2014, and the Early Childhood Education Policy (see Box 4). The Ear-ly Childhood Education Policy is comprehensive regarding the education of children with special needs (see Appendix E). As pointed out in the Situational Analysis of Children with Disabilities 2012, the major challenge to fully achieving the provisions of these conventions and declarations is the lack of resources and will, which is mani-fested more in rural communities where the pop-ulation is more widely dispersed than in urban areas. For example, children in rural areas have less access to services from NaRCIE and medical services than those from urban areas.

Children who are blind and visually impaired in Belize belong to all social, cultural and eco-nomic groups and can be found in all locations throughout the country. These children could be considered a microcosm of the larger Belizean society. The main conclusions of this situational analysis are the following:

• All children with visual impairments are in-cludedineducationwhentheydon’thaveanyotherdisabilityortheirmaindisabilityissight.However there are challenges which in-clude untrained teachers to deal with the individualized needs of these children, many classes are not conducive to learning (large classes), lack of parental support in a few cas-es, and inadequate support from NaRCIE.

• Children with visual impairments receivehealth services as normal children.All cases are identified early at birth, soon after or when they become blind, through BCVI’s network of clinics. Rehabilitation services are not pro-vided unless there is a diagnosis of irreversible blindness. In some cases children receive eye surgery. In a few cases children are not physi-cally developed for their age but the specific health reason for this is not known.

• BCVI is providing outstanding rehabilitationservicestoallknownchildrenwithvisual im-pairments throughout the country of Belize.BCVI makes great effort using creative strate-gies to raise funds and get support to sustain and expand its services offered to children in its rehabilitation program. Early stimulation and orientation and mobility training are pro-vided for 100% of children known to BCVI un-like children with other disabilities that prevent access to education, e.g., intellectual prob-lems and deafness. Most of the rehabilitation

services are provided by a dedicated team of RFOs that is continuously being upgraded and are fully supported by management. Par-ents and children are continuously recognizing and acknowledging BCVI’s exemplary work in testimonials, discussions, and interviews. The author considers BCV’s rehabilitation program exemplary in the Caribbean region based on the literature and on discussion with individu-als who are familiar with the services offered in the region.

• Amajorlimitationinmeetingtheeducation-alneedsofchildrenisthelackoftrainedteachers. Most of the teachers are not trained enough to effectively teach their students with visual impairments. A complimentary limita-tion is the use of an outdated curriculum.

Other findings include the following:

• Inclusionamongchildrenshowsnonotabledisparities by sex, age, ethnic background and geo-graphical residence. In the case of the Maya, the law that a child should be in school until fourteen is what is forcing this group to send their visually impaired children to school.

• TheCurriculumPlusSkills need tobeup-date to include the use of computer and other new technologies to keep students who are blind and visually impaired on par with normal students and to realize their full potential.

• Arelevantquestionis:Howenablingisthelegal and policy environment for children who are blind and visually impaired? The response to this question is the same as that provided for the Situ-ational Analysis of Children with Special Needs, which is that Belize has signed onto all relevant international conventions and declarations to protect the rights of children with special needs. These commitments are not yet fully reflected in our national laws. There are, however, some national plans and policies which incorporate aspects of these conventions and declarations (National Plan of Action 2004-2015, Early Child-hood Development Policy, NaRCIE Five Year Plan (2010-2015), etc.).

FINDINGS10

Table 7: International agreements relevant to children who are blind and visually impaired

Box 3: Article 23 of the Convention on the Rights of the Child

Box 4: Education Laws related to Children with Special Needs

3. Recognizes the special needs of disabled child, assistance shall be provuded free of charge wherever possible and shall be de-signed to ensure that the disabled child has effective access to and receive education, training, health care services, rehabilitation services, preparation for employment and recreational opportunites in a manner to the child’s acheiving the fullest possible social integration and individual development, in-cluding his or her cultrural and spiritual de-velopment

Education Act 2003 Part VI section 110-1: No citizen or residen of Belize shall be refused admission to any school on account of race, ethicity, language, political affiliation, region of country of origin, special needs or because of perceived social and economic status.

Education act 2003 part vi section 112-2: The education system on the whole and schools in particular shall take into account the needs of challenged students and shall provide schools with learning environment to address those needs including teacher preparation.

Education act 2003 Part VI section 112-3: Schools shall be sensitive to student with spe-cial, personal, economic, or social needs and shall develop financial, social, and student as-sistance programs at the school to assist with such students.

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• BCVI uses theCBRapproach towork for,and on the behalf of, children. It realizes that it does not have the wherewithal to provide all the services to children and recognizes that children need the community support to grow and devel-op to their full potential and enjoy all their rights.

• At least three IROsareneededtogiveallstudents who are blind and visually impaired ad-equate service for them to academically perform on par with normal students and to realize their full potential. These IROs need to be strategically placed in the country, similarly to BCVI’s RFOs.

• One of the major limitations of all thecare-giving organizations, especially NaRCIE and CARE Belize, is insufficient personnel to service the needs in the communities. Another major specific limitation is transportation to reach the clients especially those in the rural areas. The most common major limitation is lack of financial resources to buy materials to support children, to buy fuel, and to pay subsistence to reach children.

• Mostoftheparentsandgrandparentsarewilling to go the extra mile for optimal growth and development of their child or grandchild. The greatest achievements of children are observed when parents and community are supportive of children.

• Most of the teachers and principals arewilling to go the extra mile for optimal growth and development of their students. There are however a couple who need to be more assidu-ous in providing for their students who are blind and visually impaired. Teachers should continue to ensure that students with visual impairments receive appropriate educational services in the least restrictive environment appropriate to their unique needs.

• NaRCIEprovidesvery limitedservicesforchildren who are blind and visually impaired. It should provide teachers with pedagogical train-ing and ideas to deal with the individual needs of the blind or visually impaired child. These children

(or their teachers/schools) are visited only once or twice per year instead of weekly or bi-weekly and a few of them need assessments which are not forthcoming for this school year. The introduction a year ago of school inclusion coordinators is a strategy to increase the quality of the service from NaRCIE (Ministry of Education) offered to special needs students. Conceptually this initiative has some merits but needs to be supplemented with other expertise from IRO teachers. The effective-ness of this initiative will be judged over time as it matures. To complement this effort over time, all certificate and degree teacher education programs should have at least one or two courses in special education.

• Childrenwhoareblindandvisuallyimpairedin Belize City have greater access to the services of NaRCIE than those in the other districts and the rural areas of Belize district. Very few parents and teachers have the option to take their children/stu-dents to NaRCIE in Belize City to supplement the service they get at school. This is done because the IRO with the portfolio for the sight disability is located in Belize City. At the time when this study was being conducted three children were receiv-ing this service.

• The rolesofNaRCIE andBCVI as they re-late to providing services to students who are blind and visually impaired need to be defined and documented so that this information is available to all and their resources can be maximized. To com-plement this, a close working relation in the field should exist between the local IROs and RFOs to offer better service to students. For example, an RFO should be able to call the IRO to ask for an as-sessment of a student without extended delay.

• There is no national law that specificallyprotects the rights of people with disabilities and no national coordinating agency to develop dis-ability policy and national action plan to ensure persons with disabilities enjoy all their rights.

• Visual impairment occurs more in ruralthan urban areas in three districts (Corozal, Cayo, and Toledo) and there is no difference in the other districts (Orange Walk, Belize, and Stann Creek).

• Althoughallthechildrenthatareper-forming above average in school are from ur-ban areas there is not sufficient evidence to conclude that children in urban areas do bet-ter academically that those in rural areas.

• EventhoughtheFamiliesandChildrenAct states that “The State shall take appro-priate steps to ensure that children with dis-abilities are afforded equal opportunities to education” one or two schools have to be coaxed to accept children who are blind and visually im-paired and in many cases the teacher is not skilled to adequately guide the individualized intellectual development of the child. One parent expressed her dissatisfaction with the help her child was get-ting from her teacher and wanted to withdraw her child from school.

• There isstrongsupport forsurgerywhenneeded from BCVI. Over the last ten years World Pediatric Project has sponsored one eye surgery outside of the country.

• Nonationalpolicy for theemploymentofpeople with disabilities, much less policy for the employment of persons with visual impairment exists in Belize.

1. BCVI should continue its high level of support to children in providing early stimulation and CBR support, developing their orientation and mobility skills, producing Braille materials, and providing specialized equipment to students.

2. BCVI’s strategies and methods in early interven-tion and preparation for entry into school should be used as a model for the provision of support for children with disabilities other than visual impair-ment.

3. The MoE needs to enforce that all children have the right to an education.

4. The MoE needs to make operational the inclu-sion policy so that schools can and are obligated to accommodate students who are blind and visually impaired.

5. The MoE needs to respond to concerns that ser-vices for some students who are blind and visu-ally impaired are not appropriate to address their unique educational and learning needs, particular-ly their needs for instruction in reading, writing, and composition, as well as orientation and mobility and other self-help skills. Policy guidance on educating students who are blind and visually impaired urgently needs to be articulated and im-plemented by the Ministry of Education.

6. The Curriculum Plus Skills need to be updated to include recent technological advances and current innovative pedagogical practices. Considerations should be made to use computers and other new technologies in teaching children who are blind and visually impaired. This will help to facilitate the individualized needs and attention these chil-dren need to enhance their academic performance.

RECOMMENDATIONS11

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7. NaRCIE needs to develop a strategy to more regularly and systematically visit and support stu-dents who are blind and visually impaired, as well as teachers, principals, and parents. There should be at least three fully trained itinerant teachers of the blind, strategically placed around the country to give support to children who are visually im-paired on a consistent basis (weekly). This is not the role of BCVI.

8. Classroom teachers, who have a visually im-paired student in their class, need to be trained in at least basic methodologies for teaching children who are blind and visually impaired before they start teaching a visually impaired student. This can be accomplished by attracting teachers to the summer training programs for teachers offered by BCVI and NaRCIE.

9. Methodology for teaching students with special needs should be included in summer in-service training offered by the Ministry of Education and continued professional development (CPD) credits given to them by TEDS.

10. Teachers who attend summer training courses in teaching the visually impaired should continue to get TEDS credits.

11. NaRCIE should make available the service of its specialists in the other districts via monthly mobile clinics like the ophthalmologist from BCVI does to avoid the inconvenience of having to travel to Be-lize City or somewhere outside of one’s district of residency.

12. Consideration should be made to house NaR-CIE’s IROs away from the Ministry of Education office in the districts (Corozal, Orange Walk, Cayo, Stann Creek, Toledo) because they are required to perform many other functions in the department restricting them from fulfilling their main duties as an IRO. If the IRO stays at the present location the role of the IRO must be well defined and stream-lined.

13. Success stories of children who grew up through the system and are successful, productive citizens should be documented and shared with others to motivate them.

14. Parents should be trained to teach home-bound children and conduct home schooling to increase access to primary school.

15. Special programs are needed for parents who cannot cope for whatever reasons with having a child with a disability.

16. Provide information on all the opportunities available to health care especially tertiary medical care that the poor cannot afford. The information should include the name of the organization, the services provided in simple language and contact information. The systematic and sustained distri-bution of this information should be done by the three line ministries (Health, Education, Human Development) through their relevant departments (Maternal and Child Health &Health Education and Community Participation Bureau (HECOPB); NaRCIE; NCFC and COMPAR), the main NGOs working for children with disabilities (CARE and BCVI) and the associations of parents of children with special needs.

17. The services and placement provided to a child with a disability must be based on the child’s identified special education and related services needs, not on the child’s disability. The services of trained IROs are critical to realize this.

18. NaRCIE must ensure that services for stu-dents who are blind and visually impaired are appropriate to address their unique educational and learning needs, particularly their needs for instruction in reading, writing, and composition, as well as orientation and mobility and other self-help skills.

19. NaRCIE and BCVI need to work closely togeth-er to offer services to children in preschool and primary school. Similar efforts should be made with all other organizations that work with chil-dren with disabilities. Once NaRCIE has fulfilled its responsibilities then perhaps collaborationwith BCVI can be effective.

Barnett, Carla; Catzim, Adele; Humes, Dorla. (2010). Progress Report #1: Report of the National Consultations on Horizon 2030. Memo.

Beach J. (2006). Regional Workshop on Policy, Stan-dards and Regulations for ECD Services.Antigua, September 25 – 28, 2006. Memo.

Belize Council for the Visually Impaired (BCVI).An-nual Reports 2002-2011.

Black, R. (2008). The Lancet’s Series on Maternal and Child Undernutrition. Washington, DC. CARE Belize. (2005). Framework for Action for Persons with Disability.CARICOM. Regional Guideline: for Developing Pol-icy, Regulation and Standards in Early Childhood Development Services.

CBR Guidelines: Community Based- Inclusive de-velopment – WHO 2010

Community Agency for Rehabilitation and Education of Persons with disabilities– Belize (CARE – Belize) Annual Reports (2006-2010) and Strategic Plan(2008-2012)

ECLAC (Economic Commission for Latin Amer-ica and the Caribbean). (2009). A Further Study on Disabilityin the Caribbean: Rights, Commit-ment, Statistical Analysis and Monitoring. (LC/CAR/L.237), Port of Spain,Trinidad and Tobago, December.

ECLAC (Economic Commission for Latin America and the Caribbean). (2011). AFurther Study on Disability in the Caribbean: Rights, Com-mitment, Statistical Analysis, and Monitoring, Port of Spain,Trinidad and Tobago, December.

Gillett, E. (2007).National Committee for Fami-lies and Children National Plan of Action

Monitoring Report for 2004- 2007. NCFC, Belize.Government of Belize. (2000).Families and Chil-dren Act Chapter 173, Revised Edition 2000. Gov-ernment of Belize.The National Plan of Action, for children and adolescents in Belize 2004-2015.

International Disability Rights Monitor. (2004). Regional Report of the Americas 2004.Center for International Rehabilitation. Chicago, United States.

International Disability Rights Movement Report 2007 (IDRM)Living Standards Measurement Survey (LSMS) 2009.Country Poverty Assessment Team. Long-sworth, Laura (2005). The Situation of Children and Women with special Needs and Disabilities. CARE, Belize.

MDG Belize First Report 2005- UNDP and Govern-ment of Belize

Ministry of Education.Policy and Procedural Man-ual for Teachers. Ministry of Health & PAHO/WHO. (July 2010). National Eye Health Plan for Belize 2010-2014. National Committee for Families and Children. (1996), Operation Manual for Day Care Providers in Belize.Belize, Angelus Press. National Committee for Families and Children. (2010). National Plan of Action for Children and Adolescents, Monitoring Report 2004-2009.

National Resource Center for Inclusive Education (NaRCIE) – Annual Reports (2006-2010). National Resource Center for Inclusive Education (NaR-CIE), (2006). Guidelines for the Provision of Special Arrangement in National Assessments for Candidates with Special Educational Needs.Min-istry of Education.

National Resource Center for Inclusive Education (NaRCIE), (2010). Five Year Plan 2010-2015, Im-proving Inclusive and Special Education Services in Belize.

Owen, E. O. (2003). Towards Complete Compli-ance with the Convention on the Rights of the Child: An Analysis of the Laws of Belize. National Committee for Families and Children, Belize.

REFERENCES12

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PAHO. (2009).Health Systems Profile Belize: Monitoring and Analyzing Health Systems Change/Reform. Washington D.C.

Press Release.Special Olympics Belize to participate in World Winter Games in Boise, Idaho, Amandala Newspaper 6/2/2009.

Government of Belize, Statistical Institute of Belize andUNICEF. (2006).Belize Multiple Index Cluster Survey, 2006 Key Findings. Statistical Institute of Belize.2010 Census Report. Stella Maris School. (2011). School Improvement Plan.

Towards a Common Language for Functioning Disability and Health – ICF – WHO 2002

UNICEF. (2011). The Situation Analysis of Children and Women in Belize 2011, An Ecological Review. Fer De Lance Productions for United Nations Children’s Fund, Belize, Central America.

World Pediatric Project Belize chapter (WPP)- Database

World Pediatric Project. (2011). Patient Highlights 2011. Richmond Office,USA.

Young, R., Baker, T., & Wright, W. (2010). Early Childhood Development in Belize: An Assessment.

Young, R., Baker, T., & Wright, W. (2010). Early Childhood Development Policy for Belize. United States, Department of Education, Office of Special Education and Rehabilitative Services. (June 8, 2000). Educating Blind and Visually Impaired Students: Policy Guidance from OSERS.

Appendix A: Information on Braille

Braille

Braille is a writing system that enables blind and partially sighted people to read and write through touch. It was invented by Louis Braille (1809-1852), who was blind and became a teacher of the blind. It consists of patterns of raised dots arranged in cells of up to six dots in a 3 x 2 configuration. Each cell represents a letter, numeral or punctuation mark. Some frequently used words and letter combinations also have their own single cell patterns.

There are a number of different versions of Braille:

• UncontractedorGrade1,whichconsistsofthe26standardlettersofthealphabetandpunctua-tion. It is only used by people who are first starting to read Braille.

• ContractedorGrade2,whichconsistsofthe26standardlettersofthealphabet,punctuationandcontractions. The contractions are employed to save space because a Braille page cannot fit as much text as a standard printed page. Books, signs in public places, menus, and most other Braille materials are written in Contracted Braille.

Braille AlpahbetUncontracted (Grade 1) Braille

• Grade3,whichisusedmainlyinpersonalletters,diaries,andnotes,andalsoinliteraturetoa limited extent. It is a kind of shorthand, with entire words shortened to a few letters. There is no of-ficial standard for this version of Braille.

Braille has been adapted to write many different languages, including Chinese, and is also used for musical and mathematical notation, chess, computing, and science.

These letters are arranged to show how they are related: the middle row is the same as the top row with an extra dot in the bottom left corner. The bottom row is the same as the middle row with extra dot in the bottom right corner. The letter W was an afterthought and doesn’t fit this scheme, as Braille was invented for French and W is rarely used in French.

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Sample texts in Braille

Transliteration: “Be kind to others”

Sample text and other information provided by Samuel Barnes

The symbols in the first box correspond to the basic letters. Those in the second box are additional symbols.

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Appendix B: Persons Consulted/Interviewed Article 1 of the Universal Declaration of Human Rights:

Transliteration:

All human beings are born free and equal in dignity and rights. They are endowed with reason and con-science and should act towards one another in a spirit of brotherhood.

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Appendix D: Data Collection Instruments

QUESTIONNAIRE FOR TEACHERS/PRINCIPALS OF SCHOOLS

1. When last have you gotten an application from a blind or visually impaired child to attend your school?2. Have you turned away any such applicant?3. How many blind or visually impaired children are currently attending your school?4. In which classes?5. What accommodation does your school have for them?6. Do you promote “inclusion”? How?7. Are your teachers prepared to accommodate these children?8. What are their special trainings?9. Do you get support from your management to support these children?10. Do you get support from the community to support these children? If yes, what are they?11. Do you get support from the Ministry of Education to support these children? If yes, what are they?12. Do you get support from NGOs, CBOs, or FBOs to support these children? If yes, what are they?13. How do other students treat these students? Supportive, ridicule, isolate, facilitate, assist, etc.14. How can your school better serve blind or visually impaired children?15. How satisfied are you with the services offered by your school for blind or visually impaired children, on a scale of 1 to 10 with ten being the highest?16. What education legislations and/or policies are you fulfilling in offering education to blind or visually impaired children?

QUESTIONNAIRE FOR STUDENTS

1. At what age did you start school?2. Were you ever turned down by a school? If yes, what was the reason given?3. What class are you in?4. Do you have friends in your class?5. Do you feel that the students in your class like having you in their class?6. How do they treat you? Hostile, accommodating, facilitating, isolating, etc.7. How does your teacher treat you?8. Are you happy with the way you are treated by your teacher?9. Are you happy with the way you are treated by your classmates?10. What can the teacher, principal and school do to make school a better place for you?11. What is your favorite subject?12. Do you like coming to school?

QUESTIONNAIRE FOR NGOS, CBOS AND FBOS

1. Which categories of children with special needs do you assist?2. How do you assist them?3. How many are you assisting annually?

Appendix C: Training Program for BCVI’s RFOs.

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4. How many are deprived of this service annually?5. For how long have you been doing this?6. Could you do more?7. Are you collaborating with other NGOs, CBOs, and FBOs?8. What can be done to curb the occurrence of children with these disabilities?

Appendix E: Aims of the Early Childhood Education Policy relevant to children with special needs.

1. Ensure that provisions are made for the inclusion of children with special needs in all policies and pro-

grams developed for children.

2. Facilitate the participation of children with special needs in physical education, intellectual, psychological,

cultural and spiritual development activities in ways that are developmentally appropriate.

3. Ensure that all new childcare and other public service facilities are accessible to children with physical

disabilities.

4. Encourage the establishment of support groups for parents of children with all kinds of special needs.

5. Prioritize the provision of mental health services for all children with special needs.

6. Advocate for the enactment of legislation to eliminate discrimination against children with special needs,

in particular orphans and vulnerable children, in the service delivery system, including in the education,

health and child protection systems.

7. Promote the establishment and strengthening of child protection systems aimed at enhancing preven-

tion, treatment and care service to children with special needs.

8. Advocate for the development and/or amendment of relevant laws to enable the developmentally ap-

propriate and sensitive treatment of children with special needs.

9. Advocate for the development and enforcement of rules and regulations to govern all forms of substitute

care

facilities and programs for children.

10. Support child placement services for children who are abused, or orphaned by HIV/AIDS, at all times

using family preservation and non-institutional substitute care as the main strategies for placement.

11. Ensure the establishment of a strong inter-agency and inter-sectoral referral and support network to pro-

vide all necessary services to children with special needs.

12. Ensure the development of legislation, if needed, and programs that strengthen relevant agencies so

that they can improve the quality and extent of services targeted at children with special needs.

13. Promote innovative programs aimed at families from low socio-economic backgrounds to ensure that

their children will not need to be engaged in the worst forms of child labour, or in any labour activity that

interferes with their schooling.

14. Promote the mainstreaming or integration of children with special needs issues into key National Strat-

egies, Policies and Programs

Appendix F: Children at Increased Risk of Disability

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