Deafblindness

The intervener model, tactile communication, and specialized support for students with combined vision and hearing loss

For paraprofessionals and the teachers who supervise them

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| The frameDeafblindness is the combination of visual and hearing impairments that together create communication, developmental, and educational challenges so severe that programs designed solely for students who are deaf or hard of hearing, or solely for students with visual impairments, are not adequate to meet the student's needs. It is one of the most specialized areas in special education, and students with deafblindness require a uniquely trained support person -- the intervener -- whose role is fundamentally different from a standard paraprofessional. |

Understanding deafblindness

Deafblindness does not typically mean total deafness and total blindness. Most students identified as deafblind have some residual hearing and/or vision -- but the combination of the two losses creates a qualitatively different experience of the world than either loss alone. A student who is hard of hearing can use vision to compensate; a student who has low vision can use hearing to compensate. A student with both losses cannot use one sense to compensate for the other, which profoundly affects how they receive information, communicate, and make meaning of their environment.

Causes of deafblindness include: CHARGE syndrome, Usher syndrome (progressive vision loss in someone who is deaf or hard of hearing), congenital rubella syndrome, prematurity-related complications, and acquired causes (meningitis, traumatic brain injury). Each cause has a different profile of how the vision and hearing losses present, how they change over time, and what additional needs may be associated.

The intervener model

The intervener is a specialist support person trained specifically to work with students who are deafblind. The intervener role is different from a general paraprofessional role in fundamental ways:

The intervener serves as the student's primary access to environmental information -- mediating between the student and a world the student cannot fully perceive through independent sensory access

The intervener uses a consistent, individualized communication system with the student, which may include tactile sign language, touch cues, object symbols, or a combination

The intervener is trained in the specific communication and orientation and mobility approaches appropriate to the student's profile

The relationship between the intervener and the student is typically more intensive and consistent than the typical para-student relationship -- the intervener is often the student's primary communicative partner throughout the school day

CEC (Council for Exceptional Children) has developed competency standards specifically for interveners. If you are assigned to a student with deafblindness in an intervener role, you should receive formal training through a program aligned with these standards.

Tactile communication

When a student with deafblindness has limited or no functional vision, communication must occur through the tactile channel -- touch. Common tactile communication systems:

Tactile sign language

The student places their hands over the signer's hands to feel the signs being produced (hand-under-hand technique). This allows the student to receive signed language through touch rather than sight. The intervener must be fluent in the signed language being used (ASL or another system) and must adapt their signing to the tactile format.

Touch cues

Consistent, meaningful touches applied to specific parts of the body to communicate routine events or actions. Example: a specific touch on the shoulder before a transition, a different touch before eating. Touch cues must be agreed upon by the team and applied consistently by all who interact with the student.

Object symbols and tangible symbols

Concrete objects that represent activities, people, or places are used to communicate the student's schedule or choices. Example: presenting a cup before snack time, a shoe before putting on shoes to go outside. These must be individualized -- the object symbol system is designed by a specialist based on the student's sensory, cognitive, and communication profile.

Hand-under-hand guidance

Rather than hand-over-hand guidance (the adult moving the student's hands through a task), hand-under-hand places the adult's hands under the student's so the student feels what is happening from their own hands' perspective. This preserves the student's agency and avoids the aversive experience of unexpected touch.

Specialized PD and what to do if you are newly assigned

If you are assigned to support a student with deafblindness and have not received specialized training:

Contact the student's teacher of the visually impaired (TVI) and teacher of the deaf/hard of hearing immediately -- both should be part of the team

Ask whether the school's state deafblind project has resources or consultation available -- every state has a federally funded deafblind technical assistance project

Request training from the National Center on Deaf-Blindness (NCDB) or the National Family Association for Deaf-Blind (NFADB)

Do not attempt to improvise a communication system -- use the system the team has established until you are trained

Working with a student who has deafblindness without specialized training is not a safe or ethical position for either the para or the student. Advocacy for proper training and resources is part of the job.

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| Try this | Watch out for |

| Use the communication system established by the team exactly as designed -- do not improvise | Assuming that because a student has some vision or some hearing, the deafblind framework does not apply |

| Apply touch cues consistently and from the same location each time | Introducing novel communication strategies without team agreement |

| Use hand-under-hand rather than hand-over-hand guidance to preserve the student's agency | Providing unexpected or aversive touch without the consistent, predictable cue system the student relies on |

| Seek specialized training immediately if assigned to a student with deafblindness without preparation | Accepting an assignment to support a student with deafblindness without advocating for the training it requires |

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| Bottom lineDeafblindness requires the most specialized support in all of special education. The intervener is not simply a para who has learned a few signs -- they are a trained communication bridge between the student and the world. If you are in this role, training is not optional. |

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