Identification, assessment, and referral services should include early identification and intervention for infants and young children, as it is often difficult for them to make significant progress in their development if deafblindness is not addressed until school age. This process involves:

• Screening for vision and hearing, which may involve a risk-factor questionnaire
• Testing of infants and children that are flagged for risks during screening
•  Referrals to intervention services and specialists as early as possible to improve their development and independence, working in partnership with schools or child welfare systems with a multidisciplinary team, and developing an individualised plan for each child^[i]. These referrals may include additional testing and rehabilitation services with for example, audiologists, optometrists, and other specialists. This should also include referrals to information on benefits, social protection, and information and advice offered to families.

These services for infants and young children may be more cost-effective if provided within existing health and rehabilitation services and alongside interventions for other disabilities, such as single sensory impairments.

Identification, assessment, and referral services in older adults are similar. Health checks and questionnaires are a good starting point for identifying deafblindness in adults. Health centres, families, caregivers, and targeted recreational facilities, such as libraries, provide opportunities to raise awareness and disseminate risk factor tools. Risk factor tools, such as a question guide or simple screening tool for caregivers and health care staff, can help to identify those at risk of deafblindness or single sensory loss that requires further assessment and referrals^[ii]. Whether for children or adults, these services may also require:

• Screening for vision and hearing, which may involve a risk-factor questionnaire

• Identification and assessment protocols

• Training and sensitisation of health care staff to better recognise the risk factors

• Sensitisation training, information resources, and advice for family members

• Good communication for people at risk and families throughout the process for identification, assessment, and referral

• Awareness- raising in the community on deafblindness screening

• Referral pathways for further assessments for at-risk individuals

• Procurement of medical equipment used in assessments and essential medicines

• Access to specialists (e.g., occupational therapists, audiologists, ophthalmologists, etc.)

• A system for collecting data

• Centralised, tailored, and accessible information resources on deafblindness for practitioners, families, government officials, and other key stakeholders

• Coordination between government ministries and departments (e.g., health, education, etc.)

• Coordination on other disabilities (e.g., single sensory impairments)

• Coordination with rehabilitation services

• Continuity of funding^[iii].

In addition, assessments must always be a flexible, holistic process based on the latest research and experience within the field of deafblindness^[iv]. For identification screenings and assessments for deafblindness, a range of functional capacities should be included (i.e., hearing, vision, cognition, mobility, and orientation). Professional guidelines ensure consistent professional standards are met and help to prevent assumptions made by professionals) (e.g., if a child cannot hear and see, it does not mean that they have low cognitive potential)^[v].

In low-resource countries where these services do not exist, piloting of identification, assessment, and referral services tailored to the context can form a starting point. For example, a pilot programme can help to build knowledge of medical professionals on deafblindness, establish community access points for service provision, and initiate procurement of the necessary equipment to undertake assessments, while tapping into the existing government-supported health services^[vi].

To overcome the challenges of centralised or limited services for identification, assessment, and referral, pilot programmes may be initiated in other regions. Data analysis from pilot programmes can be used as evidence to highlight the impact of such services and influence local government development plans to ensure services are delivered locally in health centres and clinics^[vii].

^[i] Ibid., p. 32

^[ii] Mortensen, Ole E., When vision and hearing fail, www.sufo.dk, February 2021.

^[iii] Sense International, End of Project Early Intervention Services for Infants with Sensory Impairments in Kenya and Uganda, July 2019, p. 64-70.

^[iv] Weber, Ines, Assessment of the Functional Hearing of Children with Deafblindness, June 2020.

^[v] Nordic Welfare Centre, Revealing hidden potentials: Assessing cognition in individuals with congenital deafblindness, https://nordicwelfare.org/publikationer/hidden-potentials/, August 2020.

^[vi] Sense International, End of Project Early Intervention Services for Infants with Sensory Impairments in Kenya and Uganda, July 2019, p. 64-70.

^[vii] Sense International, A Case for the Adoption of the Screening and EI Model for CWDB as a Priority in the Wakiso District Local Government Development Plan, 2020, p. 19-22.