DAR File No. 37453

Health, Disease Control and Prevention, Health Promotion

Rule R384-201

School-Based Vision Screening for Students in Public Schools

Notice of Proposed Rule

(Amendment)

DAR File No.: 37453
Filed: 03/28/2013 03:42:39 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of school-based vision screening is to set standards and procedures for vision screening for students in public schools. This is necessary to detect vision difficulties in school age children in public schools so that follow-up for potential concerns may be done by the child's parent or guardian. Vision screening is not a substitute for a complete eye exam and vision evaluation by an ophthalmologist or optometrist. The amendment makes minor technical changes to current rule language.

Summary of the rule or change:

This rule establishes guidelines for student vision screening, including screening requirements, documenting proof of screening, training of screeners, screening documentation, and requirements for referrals. The amendment makes minor technical changes to current rule language.

State statutory or constitutional authorization for this rule:

• Section 53A-11-203

Anticipated cost or savings to:

the state budget:

All anticipated costs come out of existing budgets. The Utah Division of the Blind is financially responsible for developing and maintaining a vision screening database, maintaining staff positions for vision screening training, screening documentation, photo screening, and referral follow-up. Staff time is required to process school vision screening reports and to create and maintain a registry of results. The State Department of Health will act as consultant in the development of the database, documentation, training, and visual screening requirements in the school setting.

local governments:

The proposed rule does not add costs to existing local budgets. Existing budgets cover the costs of vision screening in school which have long been established, requiring staff time of school personnel and existing school nurses to participate in training, conduct required screenings, and prepare and submit required reports.

small businesses:

There are no costs for small businesses. The proposed rule only impacts local schools and state government entities.

persons other than small businesses, businesses, or local governmental entities:

There are no costs for small businesses. The proposed rule only impacts local schools and state government entities.

Compliance costs for affected persons:

There are no compliance costs for affected persons. Vision screenings are provided free of charge to students.

Comments by the department head on the fiscal impact the rule may have on businesses:

These changes should have no adverse impact on business.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Disease Control and Prevention, Health Promotion
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Heather Borski at the above address, by phone at 801-538-9998, by FAX at 801-538-9495, or by Internet E-mail at hborski@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/15/2013

This rule may become effective on:

05/22/2013

Authorized by:

David Patton, Executive Director

R384. Health, Disease Control and Prevention, Health Promotion.

R384-201. School-Based Vision Screening for Students in Public Schools.

R384-201-1. Authority.

(1) This rule is authorized by section 53A-11-203.

(2) The Department of Health is authorized under the rule to set standards and procedures for vision screening required by this chapter, which shall include a process for notifying the parent or guardian of a child who fails a vision screening or is identified as needing follow-up care; and provide the Division with copies of rules, standards, instructions; and recommendation for test charts necessary for conducting vision screening.

 

R384-201-2. Definitions.

(1) Division -- Division of Services for the Blind and Visually Impaired, State Office of Education.

(2) Eye care professional -- Ophthalmologist or optometrist

(3) LEA -- Local education agency

(4) Photoscreening -- Automated screening technique that facilitates vision screening in children, especially those that are difficult to screen (infants, toddlers, and children with developmental delays). It screens for a range of eye problems including most refractive errors, alignment errors, opacities (such as cataracts), and other visible eye abnormalities.

(5) Screening certificate -- Written documentation of vision screening or comprehensive eye examination by a licensed physician, [Ophthalmologist or Optometrist]or eye care professional that have been given within one year of entering a public school are acceptable.

(6) Sure Sight -- A vision screening auto-refractor that identifies nearsightedness, farsightedness, astigmatism and the difference between eyes.

(7) Significant visual impairment -- A visual impairment [serve]severe enough to interfere with learning. The term is the designation required for a child to receive services from district vision or Utah [School]Schools for the Deaf and Blind (USDB).

(8) Screener -- Pediatricians, family practitioners, [and ]nurses , or trained medical staff can perform vision screening at regular well child office visits. In addition, school volunteers and groups are trained to support vision screening programs for children. A licensed health professional providing vision care to private patients may participate as a screener in a school vision screening program for a child nine years of age or older.

(9) USDB -- Utah [School]Schools for the Deaf and Blind

(10) UDOH -- Utah Department of Health

(11) Vision Screening[ -- Vision screening using an approved eye chart to measure visual acuity in each eye separately. It is an efficient and cost-effective method to identify children with visual impairment so that a referral can be made to an appropriate eye care professional for further evaluation and treatment.]School Vision Screening programs are an efficient and cost-effective method to identify children with significant visual impairment so that a referral can be made to an appropriate eye care professional for further evaluation and treatment. School Vision Screenings must use devices and procedures approved by the Division and UDOH. The procedures for conducting screening may include, age or grade levels to be screened, tests to be used, criteria for referral and documentation of findings.

 

R384-201-3. Purpose.

The purpose of school based vision screening is to set standards and procedures for vision screening for students in public schools. This is necessary to detect vision difficulties in school age children in public schools so that follow-up for potential concerns may be done by the child's parent or guardian. Vision screening is not a substitute for a complete eye exam and vision evaluation by an [ophthalmologist or optometrist]eye care professional.

 

R384-201-4. Students Eligible for Free Screening.

The following students in an LEA may receive free vision [screening for distant visual acuity]screenings to include: distance visual acuity and other age appropriate tests that may detect visual problems upon request.

(1) [Students entering kindergarten and any student under age eight entering school for the first time in the Utah;]Students entering pre-kindergarten, kindergarten and any student age eight and under entering school for the first time in Utah;

(2) [Vision screening may be conducted for all school age children in grades 1, 2, 3, 5, 7, 9 or 10]Vision screening may be conducted for all school age children in grades pre-kindergarten through 12. The UDOH and the Division recommend screening students every other year after pre-kindergarten and kindergarten screenings, to include grades 1, 3, 5, 7, and 9 or 10 and annually for students with hearing impairment and any student referred by school personnel, parent or self to rule out vision as a reason for learning problems;

(3) Tenth grade students may be screened as part of their driver's education class; and

(4) Students who are currently receiving services from the Utah School s for the Deaf and Blind (USDB) or LEA vision staff who have a diagnosed significant visual impairment will be exempt from screening.

 

R384-201-5. Required Screening.

Required screening for students identified with disabilities in an LEA are as follows:

(1) Vision issues have to be ruled out as reasons for learning problems before Specific Learning Disability can be used as eligibility criteria and

(2) Every three years, a student must be reevaluated for eligibility for special education in all areas of suspected disability, including vision.

 

R384-201-6. Proof of Screening.

Certificate or health form from a licensed physician, nurse practioner, [Ophthalmologist or Optometrist ]eye care professional documenting a visual screening or examination given within one year of entering a public school are acceptable for school entry. All children [under age 8]age eight and under entering a public school for the first time without proof of screening mentioned above, [must]may be screened during that school year by a trained vision screener.

 

R384-201-7. Training of Screeners.

(1) A training session shall be provided by the LEA to all volunteer vision screeners prior to the start of annual vision screenings.

(2) Trainings in compliance with Division materials should be provided by the LEA.

(3) The Department of Health in collaboration with the Division shall provide train the trainer vision screening training materials.

(4) Training vision screening materials will be shared with groups that provide free vision screening services in Utah schools.

 

R384-201-8. Screening.

(1) Screenings are to be performed following criteria developed by the UDOH in collaboration with the Division.

(2) It is recommended that vision screenings are done early in the school session to provide time in that school year for adequate referral and follow-up to be done.

(3) Parents/legal guardian of a child have the right not to participate in vision screening due to personal beliefs. All parents must be notified of scheduled vision screenings by the public school to provide an opportunity to opt out of screening for their child utilizing the vision screening exemption form, available at the public school, to document a personally held belief.

(4) A public school staff member should be present at all times during vision screenings performed by any volunteer(s) including those done by an [ophthalmologist or optometrist]eye care professional. If the school nurse is not present, the school nurse should be available for consultation and re-screening.

(5) Screenings are to be done using material and procedures approved by the UDOH in collaboration with the Division. Standards and procedures are based on guidance of American Academy of Pediatrics and the American Academy of Ophthalmology and National School Nurse Association.

(6) An [ophthalmologist or optometrist]eye care professional providing vision care to private patients may participate as a screener in a free vision screening program for students nine years of age or older.

(a) An [ophthalmologist or optometrist]eye care professional screener may not market, advertise or promote their business in conjunction with the free screening at public school.

(b) The [ophthalmologist or optometrist]eye care professional will provide results of vision screening to public school [on forms]in a format(paper or electronic) as required by the Division.

(7) Any group that provides free vision screening services in the LEA will provide results of vision screening to the public school on forms required by the Division.

 

R384-201-9. Documentation and Follow-up.

All vision screening findings are to be documented in the student's [school record. Screening follow-up is to be reported to the Division by the LEA. Reported information may include but not exceed:]permanent school record. Screening failures and follow-up results for students age eight and under, who are entering school for the first time in this state, are to also be reported to the Division by the LEA

[Reported information may include but not exceed:]Reported information to the Division shall include:

(1) [Results for Pre-K and Kindergarten students who fail vision screening and referral to an ophthalmologist or optometrist for failed vision screening;]The LEA shall report to the division students who fail vision screening and referral follow-up results for children age eight and under, who are entering school for the first time in this state.

(2) Follow up information from an eye examination referral if available may be included with written permission obtained by the public school from the parent or guardian permission;

(3) Follow-up results and screening findings are to be documented [on a vision acuity screening referral form]in a format approved by the UDOH in collaboration with the Division;

(4) Screening results and follow-up information shall be sent to the Division on or before June 15 for all screenings performed during that school year;

(5) The Division is responsible to maintain a state database/registry only accessible by authorized Division staff of students who fail vision screening and who are referred for follow-up.

(6) In the interest of family privacy, the Division shall not contact a parent or guardian for information related to follow-up referral for professional eye examination unless assistance is requested in writing by the LEA.

 

R384-201-10. Requirements for Referral.

(1) Children who fail initial age appropriate school vision screening may be re-screened by a school nurse to confirm results before notification to student's parent or guardian of any impairment disclosed by the vision screening recommending further evaluation by an eye care professional. If the screening of a child 9 or older was administered in the public school by an [ophthalmologist or optometrist]eye care professional, the school nurse does not have to rescreen.

(2) The public school shall notify, in writing within 30 days from vision screening, a student's parent or guardian of any impairment disclosed by the vision screening recommending further evaluation by an [ophthalmologist or optometrist]eye care professional.

(3) An LEA may provide information to a parent or guardian of availability of follow up vision services for students.

(4) A student diagnosed by an [ophthalmologist or optometrist]eye care professional with a significant visual impairment shall be referred to the LEA vision consultant or teacher of the visually impaired prior to referral to the USDB.

 

R384-201-11. Photoscreening.

Preschool, kindergarten children, and special education students who are not candidates for regular vision screening may be screened by a school nurse using a sure sight scanner, another device approved by the Division or by Division staff with a photo screening type device. The Division is available for assistance and consultation for photo screening. Prior to photo screening by the Division or other outside agencies approved by the Division, the public school [is required to]shall obtain written permission from the parent or guardian.

References:

National Association of School Nurses (2006) Vision Screening, schools.

S. Proctor (2005) To See or not to See screening the Vision of Children in School. National Association of School Nurses.

Pediatrics Vol. 111 No.4 April 2003, pp. 902-907 at 2003 American Academy of Pediatrics ICPC-2 Category F.Eye.

 

KEY: eye exams, school vision, vision evaluations

Date of Enactment or Last Substantive Amendment: [February 20, ]2013

Authorizing, and Implemented or Interpreted Law: 53A-11-203