Case study

Palmetto Health's Vision Health Initiative

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Palmetto Health's Vision Health Initiative

Section I: Summary

Through Palmetto Health's Vision Health Initiative, low-income kindergarten through 12th grade students experience improved vision health, quality of life and greater academic performance by receiving free, comprehensive eye exams and glasses. The cost of eye exams and glasses is a barrier to receiving care.

The target population is uninsured children at or below 200 percent of federal poverty guidelines. Since 1999, the Initiative has served Richland and Lexington counties, a combined population of 563,402, but also serves rural Fairfield County and expanded to rural Pickens County in 2005. Among Richland County 's 54,697 population of children ages five to 18, 6,728 children are eligible for the program.

One Palmetto Health employee coordinates the Initiative, with support from community partners: 35 schools, local optometrists and four Wal-Mart Vision Centers. Fully funded by Palmetto Health, the annual total expense budgets for FY 2004 and FY 2005 were $152,000 and $120,000, respectively.

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Section II: Statement of purpose

A child needs healthy eyesight to walk, play and develop his or her learning abilities and imagination. Poor vision can lead to social, behavioral or emotional problems. In the United States , about 12.1 million school-age children have some form of vision impairment or low vision.

According to Prevent Blindness America, 6o percent of students identified as problem learners have undetected vision prob­lems and over 70 percent of juvenile offenders have undetected and untreated vision problems. Statistics like these hit home in South Carolina and in Palmetto Health's service area, where achievement test scores rank near the bottom nation-ally and juvenile delinquency is a serious problem.

Why our community needs the Vision Health Initiative. One in four children has impaired vision in South Carolina. According to a study by the American Academy of Pediatrics, less than 50 percent of the children identified as needing professional vision care actually receive that care. In our local school districts, children receive vision screenings, but if they are unin­sured or low-income and have a vision problem, they often go without follow-up care. They are from working poor families, and their parents cannot afford it. A ma jority of these families are African American or Hispanic Checklist for Community Needs Assessment.

Dr. Lonnie Randolph, a local optometrist, had been providing vision care to children who fell though the gaps in healthcare services for over 20 years before he and Palmetto Health's Community Outreach Advisory Taskforce worked with the Palmetto Health Office of Community Services to develop a formal vision care program to pick up where schools left off Checklist for Organizing .

"Children were doing poorly in school for the simple reason that they could not see. Giving these children the chance to excel was very important to me," recalls Dr. Randolph, now the program's volunteer medical director.

Goals and objectives. Since 1998, the Vision Health Initiative has provided children without health insurance and at or below 200 percent of the federal poverty level with vision care. This is the first and only program of its kind in Palmetto Health's service area. Over the course of the Initiative, 83 percent of children who have received comprehensive eye exams have needed glasses.

The main goals are to improve the vision health and quality of life of children by improving access to care and providing free, comprehensive eye exams and glasses. The Vision Health Initiative reaches its goals by removing barriers to vision care, effectively using community resources and creating partnerships at every level to produce a turnkey job.

Improving access. While Palmetto Health partners with local optometrists and vision care centers that provide comprehen­ sive eye exams and glasses, it pays for 100 percent of the cost of the services. When the Vision Health Initiative partnered with Wal-Mart Vision Center in 2004, more children were able to receive care. Expanding to Wal-Mart sites throughout the community has made the Initiative more stable and sustainable, and more accessible to families because of flexible appointment, pick-up and fitting times. In 2005, Palmetto Health replicated the program in Pickens County . Developing a Business Plan

The Vision Health Initiative is a turnkey program, through initial screening by the school nurse to yearly follow-up exams with an optometrist. Vision screening is performed at school. If a child needs a comprehensive eye exam, the school refers the parent to Palmetto Health's call center to schedule an appointment with a board certified optometrist. Vision screenings do not detect all types of visual impairments, so parents are encouraged to make sure that children have an eye exam each year. Parents may call to schedule appointments themselves; screening by the school nurse is not necessary. Spanish speaking staff at Palmetto Health and the Wal-Mart Vision Centers are available to assist Hispanic families.

If a child needs glasses, he or she may receive up to two pairs of glasses per year for free. Students also receive another eye exam one year later, or earlier if the optometrist deems it necessary.

Jeanne Felder, a school nurse at John P. Thomas Elementary School in Columbia, S.C., says that the children assisted by the program are from families who are working poor. "Parents are working jobs that don't have flexible leave times, or they are in school. The Vision Health Initiative does an excellent job of bringing the services to the family. No other program attempts to do this. In my 27 years as a community nurse, I know of no other program here or elsewhere that makes vision care such a reality to people who view it as an unattainable luxury," she explains.

Glasses for children on Medicaid. In previous years the Vision Health Initiative provided children on Medicaid, who currently wear glasses, with a free replacement pair. Children on Medicaid receive only one pair of glasses per year and it is very dif­ficult to get a replacement pair.

"Just because a child is on Medicaid does not mean he is receiving the vision care he needs," says Jeanne Felder, who sees them slip through the gaps in service, just like uninsured children. Medicaid children were referred by their school nurse and presented a valid (less than one year old) prescription for glasses. Once the prescription was received, glasses were ordered for the child. Due to budget cuts this service had to be cut after the first six months of Fiscal Year 2006.

Increasing awareness and knowledge. The Vision Health Initiative provides education to teachers, school nurses, and guid­ance counselors at participating schools on vision acuity and detecting vision problems among their students. School staff is instructed on how to observe students for vision problems; notice the appearance of eyes; listen for any complaints about their eyes; and observe how a student reads, writes and participates in class. With the help of a licensed optometrist, school nurses are trained on the latest vision screening tests. School nurses or other school personnel refer children to the Initiative.

Families also are recruited into the program via health fairs, print ads, radio announcements, flyers and newsletter articles, school PTO/PTA meetings and back-to-school bashes where information on eye health is distributed. In this way, parents are made aware of the issues and of how the Vision Health Initiative can help their children.

During the comprehensive eye exam, both the parent and child learn about the child's diagnosis and proper eye care. The following year, parents are reminded to have their children's eyes reexamined, since their eyesight can change quickly.

Making an impact. By successfully coordinating the Vision Health Initiative Checklist for Organizing, there is no reason a child should go without glasses. Palmetto Health has removed barriers to care and filled a critical gap in healthcare services.

"The Vision Initiative is a great support," says James Keels, a science teacher at Columbia High School. "It reaches students whose grades drop because they have difficulty concentrating and keeping up with their schoolwork. Oftentimes it's simply because they can't see clearly."

Jeanne Felder explains that she always hears children who receive new glasses say they had no idea the milk carton had words on it. "Their vision had always been a certain way; it's what they are used to. By restoring a child's sight, we're giv­ing a child so much more than a pair of glasses. It's an opportunity to learn and grow," she says.

Vision care programs for medically underserved children exist throughout the United States. Some strive to have all young children screened by age five to detect early vision problems. Others hold screenings at community events or rely on refer­rals from a social services department.

Palmetto Health's Vision Health Initiative starts at the child's school, and coordinates all eye exams and follow-up care in convenient, familiar locations at flexible times. The national program Sight for Students' is somewhat similar to Palmetto Health's Vision Health Initiative; however, Sight for Students does not serve children on Medicaid in need of a replacement pair of glasses. While virtually every school in Richland, Lexington and Fairfield counties participate in the Initiative, only a handful of schools in our service area are partners in Sight for Students. The Vision Health Initiative is a unique program locally and nationally, producing a turnkey job that removes barriers to a child in need of vision care.

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Section III: Outcomes

The Vision Health Initiative has given kindergarten through 12th grade students a stronger chance of succeeding in the classroom and in life by improving visual health through early detection, preventive care and treatment.

Between 1998 and June 2006, a total of 2,577 comprehensive eye exams and 2,438 pairs of glasses were given to children, as well as 436 replacement pairs given to children on Medicaid. Eighty-three (83) percent of children who were examined received glasses.

Chart 1: Vision Health Initiative Progress

The dramatic increase in exams by S3 percent is a result of Palmetto Health's partnership with Wal-Mart Vision Center, beginning in 2004, which increased the reach and stability of the program.

 

Table 1: Target Population Reach

Overall Population
*Target Population
7-Year Goal
Children Examined through FY 2005 and % of goal reached
FY01
FY02
FY03
FY04
FY05
Richland County children ages 5-18 = 54,697
6,728*
1,346 (20% of target)
2,248
167%
136
176
379
711
623

* CHILDREN AGES 5-18 AT OR BELOW 200% OF POVERTY WITHOUT HEALTH INSURANCE

FY 2004. In FY 2004, a total of 744 appointments were scheduled out of 627 calls from parents or caregivers needing assistance from the Vision Initiative. Of those appointments scheduled, 711 children received eye exams. Of those examined, 648 children (91 percent) needed glasses. In addition, 115 children on Medicaid received replacement glasses.

Of the students examined, 55 percent were female and 45 percent were male. Eighty (8o) percent of referrals to the program came from school nurses indicating that the children given a screening at school needed a full, comprehensive eye exam. The majority of children examined were between ages five and 12. Seventy-one (71) percent of the children were African American, 16 percent were Caucasian and 11 percent were Hispanic.

FY 2005. in FY 2005, 623 children received a comprehensive eye exam and 86 percent of them needed glasses (540 children). Over 6,700 educational contacts were made to school nurses, social workers, parents and children regarding healthy vision.

Of the students examined, 6o percent were female and 40 percent were male. The majority of referrals to the program came from vision screenings performed in partnering schools. The majority of children examined were between ages five and 12. Sixty (6o) percent of the children who received an exam were African-American, 18 percent were white and 22 percent listed another race.

HEALING EYES, CHANGING LIVES

A look at the numbers only reveal part of the Vision Health Initiative's impact. Many of the outcomes and successes are anecdotal. Numerous parents, teachers, and school nurses have shared with Palmetto Health how the Initiative has helped their children and students.

Raequan Woodruff. Now a fourth grader at Edward E. Taylor Elementary School in Columbia, S.C., Raequan Woodruff likes to learn and do well in school. Before he received his glasses through the Vision Health Initiative, he could not see the chalkboard.

His mother Latoya Woodruff says that her son's handwriting and grades were suffering. "I observed that he would squint while reading or watching television. We were able to get glasses for him through Medicaid, but you know how things happen. Raequan misplaced them. Getting a new pair was going to take at least six months. We couldn't wait that long," she explains.

Raequan's teacher referred his family to the Vision Health Initiative and Raequan received a replacement pair. "The program has made such a difference. Raequan is making A’s and B’s in school and his handwriting is perfect now," says Woodruff.

The Romero Family. Reynerio Romero's three children, who are students in Richland District schools, were suffering from headaches before they received comprehensive eye exams and glasses through the Vision Health Initiative In 2005.

"Going to Wal-Mart for the eye exams was very convenient for us," recalls Romero. "Our kids’headaches are gone, and now they can see better in class. They're also doing much better in school. The program didn't make us feel like strangers. We were treated very well."

Carrie Evans. A Richland School District One student, Carrie Evans consistently made A’s and B’s in school. Then she brought home her report card, stunning her mother with a D in Algebra. Her other grades had fallen, too. Carrie explained that she sometimes could not copy down all the algebra formulas from the board, and she was having trouble reading and studying.

Upset and worried, both mother and daughter scheduled a meeting with her teachers and guidance counselor. After explor­ing various reasons for Carrie's academic struggles, one teacher asked a basic, but insightful question: "Carrie, are you getting tired when you read? Are you having trouble seeing the board?" These were the right questions.

The school nurse provided a vision screening, which indicated Carrie's eyesight was poor, but could be corrected with lenses. Carrie's family, however, did hot have health insurance to cover a comprehensive eye exam, much less a pair of glasses. Financially, the Evans family was in the gap: employed with minimal health insurance and earning too much to qualify for Medicaid. The Vision Health Initiative was a perfect fit for Carrie.

By the end of the week, Carrie had her eye exam and a new pair of glasses. As a result, Carrie's performance in school improved, she began making A’s and B’s in Algebra again.

Strong partnerships and participation. The number of schools that participate in the Vision Health Initiative increases each year. Virtually every school in Richland, Lexington and Fairfield counties participate. In 2004, Palmetto Health contracted with vision centers located in local Wal-Mart stores to provide comprehensive eye exams. Palmetto Health also contracted with Wal-Mart Optical to provide glasses. This relationship has made the Vision Health Initiative more stable and sustainable, as well as more accessible to families because of flexible appointment, pick-up, and fitting times in the evening hours.

EVALUATION

In 2004, Palmetto Health also partnered with the University of South Carolina Arnold School of Public Health to evaluate the Initiative and provide valuable feedback through parent evaluations.

Over two-thirds of parents reported positive changes in their children, from improved academic performance and classroom behavior, to overall attitude and confidence level. Through the Vision Health Initiative, children and families have been able to overcome the disparities that prevent them from receiving vision care.

Parents' knowledge of vision health

Students' academic performance and attitude

Meeting community need

Parents' responses in the evaluation were very encouraging. As a result, the Initiative expanded to Pickens County, where Palmetto Health operates a hospital in Easley, S.C. Parent Satisfaction Survey results for FY 2005 also are available at the end of this section. (Page 9.)

Expanding the Vision Heatth Initiative. Palmetto Health identified the need to expand the initiative to Pickens County in 2005, a rural county with many children from low-income families who go without vision care. Replicating the program was easily done due to the success of the program in Richland, Lexington and Fairfield counties.

The program works the same way, with school nurses referring children who need a comprehensive eye exam to the Vision Health Initiative. Partner schools began offering vision screening and referrals in May 2005. Exams are performed by Hinson Family Practice located inside Wal-Mart. Parents also can contact Palmetto Health's call center in Columbia, via a toll-free number, to request a vision screening for their child.

Recognition. In 2005, the Vision Health Initiative received one of five American Hospital Association's NOVA Awards for its impact on improving community health status. The American Hospital Association also recognized the Initiative in the first of a series of fax communications entitled "Community Connections" sent to the United States Government in spring 2006 regarding hospitals around the country doing exceptional community outreach work. An example of the fax can be viewed at www.caringforcommunities.org, on the "Hospitals in Action" page.

 

VISION INITIATIVE PATIENT SATISFACTION SURVEY RESULTS

FY 2005 October 1, 2004 to September 30, 2005
Number of Respondents: 56 Males: 19 Females: 25 No Indication of Gender: 12

Questions
True Positive
Somewhat True
Positive
Somewhat False
Negative
False
Negative
Total Responses for Each Question
 
1
2
3
4
 
FREQ.
%*
FREQ.
%*
FREQ.
%*
FREQ.
%*

1. I will tell my family and friends about this screening program.

52
92.8
3
5.4
0
1
1.8
6

2. My questions about the exam were answered.

53
94.6
3
5.4
0
-
0
-
56

3. The person who did the screening knew what he or she was doing.

53
94.5
3
5.4
0
0
56

4. I was treated with respect.

53
94.5
3
5.4
0
-
0
56

5. I was seen in a timely manner.
50
89.3
4
7.1
0
2
3.6
56

6. It was easy to reach someone for questions about my child's eye exam.

51
91.1
5
8.9
0
-
0
-
56

7. The facility was clean.

55
98.2
1
1.8
0
-
0
-
56

8. The staff was friendly.
56
100
0
0
-
0
56

9. I would attend another event held by this organization.

54
98.2
1
1.8
0
0
55

io. My child received his/her glasses in a timely manner.

43
79.6
2
3.7
1
1.9
8
14.8
54

* Denominator = Total responses for each question
** For each question, a MEAN of z.ooo is the most positive result, and a MEAN of 4.ooo Is the least positive result.

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Contact information

For more information, contact:

Tiffany Sullivan

Palmetto Health
Phone: 803-296-3070
South Carolina

tiffany.sullivan@palmettohealth.org
http://www.palmettohealth.org

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