It has been demonstrated that services offering specialist support for children who have a visual impairment vary considerably from LEA to LEA (Dawkins, 1991). The discrepancy between the quality and frequency is reflected across all areas of special need (Pearson and Lindsay, 1987). The support received by children who are experiencing difficulties, and their teachers, will differ in standard and amount according to the identified need, the part of the country in which they live, and the special needs policy of the education authority and school. In this chapter there will be discussion of some of the difficulties encountered by staff in providing adequate and effective support. The difficulties listed below will also vary in occurrence and degree. We are not suggesting that every service experiences all the ‘stumbling blocks’ which we describe, we are, however, recording common characteristics which have been cited as impairing effective and efficient service delivery.