Abstract
Approximately 20% of school-age children have a vision problem. Screening is an effective way to detect visual impairments, although only if adequate follow-up is available. Here, we evaluate the impact of hiring full-time nurses in four underserved schools on the likelihood of increasing follow-up for treatment after vision screening. First, we compared descriptive screening follow-up data from the intervention schools with that of five matched schools with part-time nurses in San Jose, California, from 2008 to 2012. The intervention schools had around 2800 low-income, minority children each year, and the five comparison schools had around 3445. Secondly, we conducted a qualitative analysis of open-ended survey responses from 129 teachers in the nine participating schools. In the final year, 96% of the students screened and referred for possible vision problems in schools with full-time nurses were followed up and examined by a health care provider. Yet, only 67% of students screened in comparison schools were examined. Teachers in schools with full-time nurses reported that follow-up of vision problems and getting glasses for students was the most beneficial activity performed by the nurses. School nurses can effectively increase medical care coordination and follow-up of vision screening in low-income communities.
Highlights
Student enrollment in public schools across the United States is expected to reach 51.7 million by fall of 2026 [1], and according to recent estimates, 51% of students currently enrolled in public schools are from low-income families [2]
According to the Centers for Disease Control and Prevention (CDC) children from families with incomes below poverty level are less likely to see an eye care provider compared to children from families with incomes >200% of the federal poverty level (17% versus 23%) [7], and children lacking health insurance have greater unmet vision needs compared to children with vision insurance
In this paper we first provide a brief review of school-based screening programs, and we investigate the impact that having full-time nurses in schools can have in increasing follow-up to vision screening among low income and minority children
Summary
Student enrollment in public schools across the United States is expected to reach 51.7 million by fall of 2026 [1], and according to recent estimates, 51% of students currently enrolled in public schools are from low-income families [2]. The California Department of Education supports schools by providing health and school nursing services for vision, hearing, and scoliosis screening [13]. According to the National Association of School Nurses, (NASN), school nurses are required to conduct screenings, referrals, and follow-up activities in schools as part of their role to provide secondary prevention services for health concerns that can be detected early and treated in a timely manner [18]. In 139 Indiana schools, students from lower median family incomes screened for vision problems were more likely to get referrals to eye care providers (referral rate 14.6%) compared to students with higher median family income (referral rate 8.5%). In 10 North Carolina schools, about two-thirds of the students with abnormal vision screening received documented follow-up with an optometrist or ophthalmologist when school nurses were actively involved in regular follow-up with parents and providers [22]
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