The work of the National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness supports the development of a coordinated public health infrastructure to promote and ensure a comprehensive, multi-tiered continuum of vision care and eye health for young children in public health, education, and primary care settings. Improvements to the system serving children’s vision result in improved quality of care, better coordination of care, and reduced duplication of health services. The NCCVEH brings this work to life through strong partnerships, sound science, and targeted policy initiatives.
The NCCVEH focuses its efforts on achieving the following three approaches:
- Provide national leadership in dissemination of best practices, infrastructure development, professional education, and national vision screening guidelines that ensure a continuum of vision and eye health care for children;
- Advance state-based performance improvement systems for vision health, screening guidelines, and a mechanism for uniform vision data collection and reporting; and
- Provide technical assistance to states in the implementation of strategies for vision screening, establishing quality improvement measures, and improving mechanisms for surveillance.
The work of the Center is guided by the Advisory Committee of the Center – a body of nationally recognized leaders in children’s health, vision care, public health, early education and childcare, and vision research, as well as family advocates. The Committee is charged with ensuring quality and sound science in the products of the Center.
Attention to vision and eye health in young children is critical to long-term vision outcomes and improved learning ability. Unfortunately, many children do not receive timely vision screenings or have access to needed eye care. Improvements to key public health activities – including surveillance, vision screening, access to eye care, and establishing policies that promote action – are critical steps for improving children’s vision and eye health in the United States. Presently there are numerous entities engaged in vision screenings (pediatricians, early-education settings, public health, and community-based organizations.) The challenge with diverse efforts to screen children is there is no consistency in the delivery of vision screening, no coordination of care at the child-level, and certainly no systematic effort in capturing outcomes data or establishing measures of quality and effectiveness.
Undetected and untreated vision problems in children are a significant public health issue. Key considerations for the role of healthy vision in children as a function of long-term health include:
- Undiagnosed and untreated amblyopia has a detrimental impact on a child’s development and motor function, leading to long-term impairment of vision, physical abilities, and potential earning capacity.
- Uncorrected moderate vision impairment has been shown to impact pre-reading skills in young children. Early vision problems may have a predisposition to early learning problems without proper intervention and treatment.
- There is a cumulative cost savings and improved quality of life demonstrated with early intervention of vision problems in young children when they are most readily treatable and relatively inexpensive.
Vision problems affect more than 12.1 million school-age children and 5-10% percent of preschool aged children. If not detected and treated early, vision impairment could affect all aspects of life. While policies and guidelines for vision screening in primary care exist – such as Bright Futures and the American Academy of Pediatrics Preferred Practice Patterns – only 52% of children ages 3 through 5 are screened for vision problems. Most public health systems don’t even consider children’s eye health during their needs assessment or early education planning processes. Early treatment of amblyopia results in improved visual outcomes. In addition, optical correction of significant refractive error may be related to improved child development and school readiness. Currently only 15 states require a vision screening or eye exam for children ages 3 through 5 years old prior to their entry into Kindergarten. The development of an evidence-based and uniformly adopted system for children’s vision and eye health is critically needed at the state and national level.
The work approach of the NCCVEH includes:
- Engaging national experts in children’s vision, public health professionals, researchers, educators, and family advocates in guiding the work of the NCCVEH;
- Identifying and eliminating barriers to care that prevent children from receiving eye care or prescribed treatments;
- Establishing and disseminating system enhancements that decrease costly duplication of services and increase communication among providers;
- Providing resources needed by vision screeners, providers, and families that will contribute to better vision and eye health in children; and
- Supporting children’s vision and eye health efforts nationally with technical assistance, resources, education, and awareness.
While the Center has achieved a number of objectives over the past year through this work approach, prime among these has been the publishing of recommendations providing an evidence-based approach to vision screening in children ages 3 through 5, as well as system-based public health strategies to ensure improved surveillance and program accountability. The panel of experts that the NCCVEH worked with wrote three articles targeting children aged 36 to less than 72 months.
These recommendations were published as the lead articles in the January 2015 issue of the Journal of Optometry and Vision Science, and are further discussed on a special NCCVEH-hosted Vision Health Systems for Preschool-Age Children website developed to directly support the recommendations from the articles and to disseminate them for use at the state and local level. These recommendations will shape state and national approaches to children’s eye health for years to come driving uniformity in screening approach, improved follow-up to eye care, and reduced health disparities for vision.
This grant program is committed to encouraging partnerships to foster collaboration and innovation to support healthy vision for children. NCCVEH and its five state pilot programs (located in Ohio, Illinois, Massachusetts, Georgia, and North Carolina) have worked with numerous key national and state organizations to promote a uniform approach to children’s vision in the U.S. A new partnership that will disseminate the best practices developed by the NCCVEH on the national level is our engagement with the More Hopeful Futures Campaign as the key partner on children’s vision and vision screenings. The More Hopeful Futures Campaign (to be launched nationally in 2017) will be the next phase of the Campaign for Grade-Level Reading’s (CGLR) decade-long effort to increase reading proficiency among children from low-income families. Over the next three years, CGLR and key partners will “road test” plans for the initiative, reaching at least 50,000 children during this period with an enhanced package of screenings and supports designed to accelerate ongoing efforts to improve school readiness, school attendance and summer learning.
At the state level, our pilot site programs have engaged in several activities that have advanced the system for children’s vision in each of their respective areas:
- MA: Established a partnership with the Massachusetts Department of Public Health- School Health Services to provide eye health education and information that links vision services to high risk children and hard to reach families; Established a workgroup to seek out a new approach to vision assessment for children younger than 3 years old through a thorough review of vision questions on developmental screening tools used in pediatric practices, public schools, and community based programs; Created a video on the importance of children’s vision for healthy development and the role of primary care providers; Established two new partnerships, one with the MA Department of Early Education and Care Coordinated (EEC) Family and Community Engagement grantees and another with LiveWell Springfield-KIDS coalition. The goal of both partnerships is to provide eye health education and information that links vision services to high risk children and hard to reach families.
- OH: Ohio is established a new collaboration with the Ohio Head Start Association based on NCCVEH’s relationship with the National Head Start Association to improve children’s vision and eye health programs in early learning environments; Provided training on vision screening data collection procedures integrated into the state immunization information system to 751 primary care providers, nurses, public health professionals, and early educators. Training topics included a review of required data collection points, establishing secured access to the data system, and navigating a child’s vision health record in the system; The Ohio pilot program site is working with the Ohio Chapter AAP and the Ohio Department of Health to conduct a formal Learning Collaborative on Pediatric Preschool Vision Screening Practices.
- NC: Collaborated with the Department of Public Instruction and a Committee of professionals to create the Guiding Practices for Vision, serving children with special healthcare needs age birth to 5 years; Expanded access to vision screening training recertification for school nurses in North Carolina by creating a webinar-based training; Contracted by the North Carolina Department of Public Health- Division of Public Health, School Health Unit of the Children’s Health Branch to provide vision screening training to 3,093 state school nurse consultants; Distributed vision and eye health resource guides to every school nurse in the state and each of the county health departments.
- GA: Collaborated with Children’s Healthcare of Atlanta in the development of the Georgia School Health Resource Manual, providing lead in the development of the vision screening chapter (chapter 8); Conducted training sessions on instrument-based vision screening for children for public health nurses in 26 health departments across Georgia; Worked with the Georgia Department of Education to revise the required health screening form for school entry- Form 3300; Eye health information, parent friendly referral information, a parent education newsletter with frequently asked questions, and financial assistance information was distributed to the families of 28,504 children.
- IL: Worked with the Health Connections subcommittee to establish recommendations for children’s vision programs and policies- one of the top health priorities selected by the Illinois Early Learning Council; Planned and conducted a Children’s Vision Summit in partnership with the Illinois Head Start Association in March 2015, based on much of the work NCCVEH did for the Year of Children’s Vision Partnership with the National Head Start Association.
NCCVEH and the five state pilot site locations regularly provide personalized technical assistance to many state level programs as they seek to improve their vision health program according to the recommendations developed by the NCCVEH. In addition to developing and publishing these papers, the NCCVEH has provided 143 sessions of technical assistance to individuals in 31 states including the District of Columbia. Additional technical assistance was provided to the Office of Head Start National Center for Health, Center for Medicaid and CHIP Services- Centers for Medicare & Medicaid Services, the National Association of School Nurses, and American Board of Pediatrics. The technical assistance process is essential to NCCVEH and the state programs as it allows us to disseminate the published recommendations; and we also have an opportunity to direct new resource development to meet common needs and questions.
The National Center for Children’s Vision and Eye Health, its Advisory Committee, and state pilot programs regularly develop and disseminate educational materials and information in support of a comprehensive approach to children’s vision as directed by the National Expert Panel’s recommendations. The NCCVEH has taken an approach to resource development that ensures members of the targeted stakeholder groups are engaged in their development and take into account cultural needs and literacy levels to encourage use and understanding of resources. The NCCVEH has produced a considerable number of resources and tools that support a strong vision health system for children, including:
- Four recorded webinars on a strong system for children’s vision, the Affordable Care Act, and common vision problems in children
- An article published in Childcare Exchange magazine, reaching more than 28,000 subscribers
- An article published in the journal NASN School Nurse, reaching more than 19,000 subscribers
- An evaluation tool that assesses strengths and weaknesses in existing vision health systems and recommends resources to improve the system
- A vision screening referral letter that can be used in educational settings, primary care offices, and childcare settings (available in English and Spanish)
- A website to support the Year of Children’s Vision initiative: http://nationalcenter.preventblindness.org/year-childrens-vision
- A new process for reviewing vision screening instruments and educating consumers on what device would be most effective for their vision program
- A vision screening training curriculum and support materials that can be presented in person or through online modules (starting August 2015) based on the published recommendations
“The values that the First NonProfit Foundation brings to their grant making mirror those of Prevent Blindness and its National Center for Children’s Vision and Eye Health- seeking a creative, sustainable solution to society’s problems. The grant that Prevent Blindness received from First NonProfit has allowed us to advance the work of our center resulting in systematic changes on state and national levels leading to improved vision and eye health in young children. This work would not be possible without engaged partners that share a mutual vision for best-practices in prevention of vision loss. Thank you!”