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Supporting the Mental Health of Blind and Low Vision Individuals Through O&M

May Nguyen, MS, LEP, NCSP, ACUE

California Association of Orientation and Mobility Specialists (CAOMS) Conference

December 7, 2024

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Land Acknowledgement

I would like to recognize that while we gather in Garden Grove, we are guests on the unceded land of the First People of this region, the Acjachemen and Gabrieleno Tongva people. I honor their deep connections to the land, rich and diverse cultures, and enduring contributions to these territories. I support the sovereignty of these and other Indigenous peoples.

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Acknowledgements

This presentation is an adaptation and update of the "Visual Impairments & Mental Health" webinar created by Ashley McDaid, May Nguyen, and Annika Hodges for the California Association of School Psychologists 2024 Spring Institute.

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Learning Objectives

  • Identify blindness and low vision impacts on mental health and the relationship between orientation and mobility and mental health.
  • Explore and try practical strategies to support the mental health of blind and low vision students.
  • List resources for further learning to integrate strategies into their practice.

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What is one thing that always brings a smile to your face, no matter how tough your day has been?

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Impacts of blindness and low vision on mental health and the relationship between orientation and mobility and mental health.

Learning Objective 1

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Mental Health of Blind and Low Vision Adults 1 of 2

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Mental Health of Blind and Low Vision Adults 2 of 2

  • In "Psychological Impact of Vision Loss" [Journal of Mental Health and Clinical Psychology], Boagey and colleagues (2022) found that vision loss affects individuals’ mental health and sense of self and that "any mention of suicidal ideation should be taken very seriously, as sight loss has been linked to an increased risk of suicide" (p. 29).

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Hadley Presents Podcast Clip 1

Listen to a clip from Hadly Presents: Emotions, Mental Health, and Vision Loss (Episode 118) with clinical psychologist Dr. Ann Wagner. Start at 4:14.

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Mental Health of Blind and Low Vision Youths 1 of 2

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Mental Health of Blind and Low Vision Youths 2 of 2

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Risk Factors That May Negatively Influence Mental Well-being

  • Social interaction challenges (Augestad, 2017a) and social isolation
  • Difficulty with the adjustment to vision loss 
    • Concern regarding the degree of vision loss or worsening or progressive vision loss (Augestad, 2017b; Demmin & Silverstein, 2020)
    • Stress related to healthcare and treatments
    • Stigma and discrimination (experienced, perceived, or anticipated)
  • Impacts on independence, overprotection (Augestad, 2017b)
  • Limited participation in physical activities (Oh et al., 2004) and reduced mobility (Augestad, 2017b)

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Coach Niño's Experiences with Low Vision

Audio clip: Coach Niño shared his lived experiences [Google Drive]

  • Stargardt  
  • 20/200 vision since 13
  • Challenges with explaining visual experience to others and finding understanding within himself

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Coach Niño on Mental Health

Coach Niño sharing his experiences [Google Drive]

  • Middle school and early high school years were the toughest.
  • Depression, sadness, not loving self.
  • Affected schoolwork, relationships, and confidence.
  • Started to accept and feel peace sophomore year.

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Implications for practice for multidisciplinary teams

  • The research findings highlight the importance of screening and assessment of social-emotional functioning and the need for mental health support. It is important for all students to develop coping skills.
    • Routine screening and monitoring of mental well-being is recommended for individuals with visual impairment (Demmin & Silverstein, 2020; Robertson et al., 2021), specifically screening for anxiety and depression (Lundeen et al., 2022).
    • “Assessment of emotional status should be a component of every assessment of a student who is blind or visually impaired” (Russo, 2003, p. 169). 

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Implications for practice for O&M Specialists

  • Develop and maintain positive relationships with your students!
  • Inform school mental health professionals of blind and low vision students' needs.
  • Ensure instruction on the Expanded Core Curriculum, including independent living skills, social skills, and self-determination.
  • All school staff are highly recommended to be regularly trained in suicide awareness and prevention. Gatekeeper training teaches people to identify warning signs and refer youth to appropriate services. Example: Zero Suicide Alliance (ZSA) Suicide Awareness Training is free for anyone 16 years old or older.

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How do you build and maintain positive relationships with your students? Write ideas in this Google Doc.

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Coping with vision differences or loss

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Factors Associated With Improved Mental Well-Being �1 of 2

  • Services and interventions that address psychological and practical daily living skills assist in adjusting to vision loss, such as the following factors.
    • Early intervention and low vision rehabilitation services (Elsman et al., 2019)
    • Physical activity, sports camps (Elsman et al., 2019) and independence in mobility (Augestad, 2017b)
    • Social support and the development of social skills and friendships (Augestad, 2017b)

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Factors Associated With Improved Mental Well-Being �2 of 2

  • Services and interventions that address psychological and practical daily living skills assist in adjusting to vision loss, such as the following factors (continued).
    • Recreation and leisure activities (Augestad, 2017b)
    • Counseling (e.g., group, individual, grief therapy, and cognitive therapy) (Elsman et al., 2019; Partow et al., 2021; Ueda, 2017)
    • Psychoeducation and/or support groups for families

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Coach Niño on Mental Health & Social Support

Coach Niño audio clip [Google Drive]

  • Looking at the bright side of things as well as accepting reality has helped.
  • Approaching things with a sense of humor.
  • The people around you and the environment play a big part in helping mental health.

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Adjustment to Vision Loss Considerations

  • Adjustment to vision loss may be a fluid and ongoing process as the students face new environmental demands and expectations over time.
  • Per "This is me: A qualitative investigation of young people's experience of growing up with visual impairment" [PLoS ONE], later onset of visual impairment (i.e., not congenital vision loss) and fluctuating visual functioning influence the outcome and process of adjustment and incorporation of this aspect of themselves into their sense of identity (Robertson et al., 2021).

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Various Adjustment to Vision Loss Models and Perspectives 1 of 2

  • While various models exist, adjustment to vision loss depends on individuals and their situations. Some may move quickly or slowly through stages, skip a stage, or cycle through the stages. Generally, there is a stage of reacting to the vision loss and rebuilding stage.
  • In "Psychological Impact of Vision Loss" [Journal of Mental Health and Clinical Psychology], participants described stages of coping with their diagnosis leading to vision loss similar to stage theories of grief, such as Kübler-Ross’s model (i.e., denial, anger, bargaining, depression, and acceptance) (Boagey et al., 2022).

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Various Adjustment to Vision Loss Models and Perspectives 2 of 2

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Hadley Presents Podcast Clip 2

Listen to a clip from Hadly Presents: Emotions, Mental Health, and Vision Loss (Episode 118) with clinical psychologist Dr. Ann Wagner. Start at 6:50.

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Practical Strategies

Learning Objective 2

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Coach Niño on What Others Need to Know

Coach Niño audio clip [Google Drive]

  • It's okay to ask questions.
  • It can help build confidence to learn who you are in terms of what you can or can't do.
  • Find an enjoyable outlet.
  • Be open-minded about what you can do.

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Adjustment to Vision Loss Strategies 1 of 2

  • Validate and explore the student's thoughts and feelings about vision loss.
    • Discuss thoughts and feelings around VI materials and tools, such as braille, large print, video magnifiers, and white canes.
    • Consider occasional activities with other students who use similar compensatory strategies or devices to normalize their use.
    • Review described and captioned media or books with characters who use similar strategies or tools.
  • Help the student create a document, book, presentation, or video about their visual impairment, functional vision, strengths, and needs.

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Adjustment to Vision Loss Strategies 2 of 2

  • Create opportunities to practice self-advocacy and assertive communication skills.
    • Roleplay talking about their visual impairment.
    • Practice problem-solving with stressful scenarios (e.g., identify the problem, brainstorm various ways to address the problem, and choose one to try out).
    • Reflect on previous experiences where the student successfully managed stressful situations and what worked in those situations.
  • Encourage reframing to shift to a more positive or kinder self-dialogue and promote resiliency.

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Practice Activity: Reframe the following statements.

  • Example: I can't do it. I give up. → I'm still learning. This is really hard, but I'll keep trying.
  • I'm always making mistakes. I'm so stupid.
  • This is too hard. I hate this.
  • Everyone else is doing better than me. I'm a failure.

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Diaphragmatic Breathing

  • Diaphragmatic breathing is the slow and deep breathing using the diaphragm (a dome-shaped muscle under our lungs) to help get more air in the lungs and more oxygen to the body and brain.
  • Kinesthetic guide: High 5 breathing using the tactile guide of hands and fingers 
    • Directions: Hold your hand up with your palm facing you. Start at the outside edge of the thumb. Use the index finger on the other hand to move up to the top. Breathe in as it reaches the top – pause very briefly (do not hold). Breathe out when tracing down the other side of the thumb. Trace each finger.

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Mindfulness

  • Mindfulness involves being aware of how your body feels and your surroundings.
  • Senses Check
    • 4 things you can touch
    • 3 things you can hear
    • 2 things you can smell
    • 1 thing you can taste
    • Note: Depending on the student's functional vision and preferences, you may incorporate sight for the senses check as "5 things you can see"
  • Wake Up Shake Up by Touchdown Dance: audio described exercise
  • CSB's Mindfulness Curriculum (McKerracher & Green, 2020)

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Promote Physical Exercise 1 of 2

  • Does your student have adapted physical education services?
  • Bay Area Outreach and Recreation Program (BORP) (Berkeley & Bay Area)
    • Goalball practices (Berkeley)
    • Virtual fitness classes: Mindful movement, rumba, & functional strength training
    • Recordings on YouTube
  • Blind Fitness (Santa Barbara) - in-person events, such as beach run and walk, adaptive surf clinic, surrey bike rides, and more!

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Promote Physical Exercise 2 of 2

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Connection and Belonging 1 of 5

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Connection and Belonging 2 of 5

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Connection and Belonging 3 of 5

  • Camp Bloomfield - Wayfinder Family Services 
    • Youth/Teen Camp, Family Session, Youth/Teen Inclusion Camp, and Adult Camp
    • Locations: Pathfinder Ranch (near the San Bernardino National Forest), Camp Bob Waldorf (Glendale), and Lions Camp at Teresita Pines (near Wrightwood, CA)
  • Enchanted Hills Camp - LightHouse for the Blind and Visually Impaired (Napa)
    • Many options: Teen Session, Youth Employment Services Summer Academy, STEM Camp, Music Camp and Concert, Little Learners Camp, and more!
    • Counselor-in-Training and Leadership Development Program for ages 16 to 18 

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Connection and Belonging 4 of 5

  • LightHouse for the Blind and Visually Impaired (San Francisco)
    • Calendar for online and in-person events
    • Lighthouse Little Learners for preschool-age students
  • Beyond Blindness (Santa Ana)
    • Summer Camp
    • Social Society: free after-school peer group for ages 8 to 18
    • Learning Link: free parent and child program for ages 0 to 5
    • Preschool Program for ages 3 to 6

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Connection and Belonging 5 of 5

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Case Study: Autumn

  • Listen to audio clips (not open-access).
  • What would you say to teenage Autumn?
  • How might you support her?

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Case Study: Annika

  • Adolescent onset with uncertain prognosis. Visual difficulties for her entire life, but higher degree impairments began at 15
  • Chronic eye inflammation with progressive cataracts and floaters. Near complete blindness in left eye and low vision in the right
  • Everyday experiences: multiple daily medications, unable to read standard font and packaging without assistance, and use of assistive technology
  • Going through high school with a visual impairment was difficult.
    • Anger: feeling cheated out of time, ability, and life
    • Depression: feeling helplessness, grief, and loss
    • Anxiety: constant worry about the future of my vision and treatment
  • Living at the intersection of disability and chronic illness: coping with the loss of abilities and being a lifelong medical patient

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Resources for Further Learning

Learning Objective 3

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Free Resources

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Resources Available for Purchases

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What is your action plan to further develop your capacity to support the mental well-being of your students?

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References

Document with references for resources cited in the presentation (Google Docs)

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Thank you

May Nguyen

mnguyen@csb-cde.ca.gov