Coordination of Care Vision and Hearing Referral DPAS 2 Component 5 Growth Goals Indicator 3 and 4 Susan Hoffmann MSN, RN, NCSN

School nurses provide quality health care and intervene with actual and potential health problems

School nursing interventions impact the student’s health & well-being Optimal student health Optimal student health impacts the student’s ability to learn impacts the student’s ability to learn Hearing and vision are critical to academic success Hearing and vision are critical to academic success

The school nurse coordinates care delivery… Students referred from vision or hearing screening Will be seen by a healthcare provider

Why would a school nurse would want to choose this indicator? 2.0 Regulation 2.0 Regulation: Vision and Hearing Screening Each public school student in kindergarten and in grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year In addition to the screening requirements in 2.1.1, screening shall also be provided to new enterers, students referred by a teacher or an administrator, and students considered for special education Driver education students shall have a vision screening within a year prior to their in car driving hours The school nurse shall record the results on the Delaware School Health Record Form and shall notify the parent, guardian or Relative Caregiver or the student if 18 years or older, or an unaccompanied homeless youth (as defined by 42 USC 11434a) if the student has a suspected problem.

Which students should have a vision screening? Grades kindergarten, grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year. Grades kindergarten, grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year. New enterers New enterers Those being considered for special education Those being considered for special education Teacher referrals Teacher referrals Driver education students shall have a vision screening within a year prior to their in car driving hours. Driver education students shall have a vision screening within a year prior to their in car driving hours.

Mandated hearing screenings Grades kindergarten, Grades kindergarten, grades 2, 4, 7 and grades 9 or 10 shall receive a vision and a hearing screening by January 15th of each school year. New enterers New enterers Those being considered for special education Those being considered for special education Teacher referrals Teacher referrals

What type of tests should be used? First time screening First time screening Routine screenings Routine screenings Referral criteria Referral criteria

How to choose a cohort: Include the entire school and should not be broken into smaller cohorts Include the entire school and should not be broken into smaller cohorts Screening Completion Rate from previous year compared to current year Screening Completion Rate from previous year compared to current year There must be a minimum of 10 students referred in the previous year There must be a minimum of 10 students referred in the previous year

How to get a baseline Cognos Report Cognos Report Standard DOE Public Reports > Medical Reports > Annual Reports > Incomplete Referrals Current Consider using percentage of a comparable cohort of schools Consider using percentage of a comparable cohort of schools

Calculate the baseline Determine the Vision Screening Referral Completion Determine the Vision Screening Referral Completion Divide the Number of Completions by the Number of Referrals to determine the percentage of Completions. Divide the Number of Completions by the Number of Referrals to determine the percentage of Completions.

Do the math….. # of Completions = percentage complete # of Completions = percentage complete Total # referred Example: Example: 25 complete =.50 (50%) 50 referred 50 referred

How to calculate the growth FY12 State Hearing Screening Referral Completion Rates STATEWIDE: 53% STATEWIDE: 53% GRADES PreK – 2: 53% GRADES PreK – 2: 53% GRADES 3 – 5: 38% GRADES 3 – 5: 38% GRADES 6 – 8: 21% GRADES 6 – 8: 21% GRADES 9 – 12: 46% GRADES 9 – 12: 46% FY12 State Vision Screening Referral Completion Rates STATEWIDE: 38% STATEWIDE: 38% GRADES PreK – 2: 42% GRADES PreK – 2: 42% GRADES 3 – 5: 34% GRADES 3 – 5: 34% GRADES 6 – 8: 29% GRADES 6 – 8: 29% GRADES 9 – 12: 44% GRADES 9 – 12: 44%

Target goal –Close the gap Between baseline percentages by 50% or other agreed upon %

Set the growth measure If previous year’s percentage is less than the state or district completion percentage Set a goal to close the percentage difference by 50% Or percentage agreed upon with administrator

Setting the growth goal if: Nurse is new school nursing Nurse is new to the school Or if the school has changed student configuration (by adding or subtracting grades or cohorts of students) Or if the school has changed student configuration (by adding or subtracting grades or cohorts of students) Targeted goal district or state percentage minus 5%.

Examples: Percentage at end of previous school year Percentage at end of current school year (state or district) Difference between percentage s (school – state/distri ct) Minimal growth (50% of the difference if it was a negative difference, i.e., the state/district was higher than the school) Targeted Goal (previous year’s percentage plus the minimal growth) School #140%60% (state) - 20%10%50% School #275%60%+15%075% School #350%42% (district) 85% (state) * -35% 17.5%67.5% School #4 (new nurse) No data (nurse was not in a school) 42% (district) 85% (state) n/a 42% - 5% = 38% **

A completed referral can be documented if: –A healthcare provider’s note is received –The student has new glasses –The healthcare provider’s office will verbally confirm a visit –The parent/guardian confirms a visit –A re-screening by the school nurse indicates there is no need for a referral

A completed referral can NOT be documented based on the number of contacts the nurse makes based on the number of contacts the nurse makes For example, the nurse may have made multiple interventions without success but this is not a completed referral. For example, the nurse may have made multiple interventions without success but this is not a completed referral.

Strategies for ensuring growth Identify the root cause for non- completion

Review Documentation What codes to use (Is the coding correct?) What codes to use (Is the coding correct?) Document better in the future Document better in the future So you can use the data next year So you can use the data next year Were all REFERRAL Completions? Were all REFERRAL Completions? Check with the student to ascertain if the referral was completed but not reported to the school nurse. Check with the student to ascertain if the referral was completed but not reported to the school nurse. A doctor’s note is not required for the school nurse to document completion. A doctor’s note is not required for the school nurse to document completion.

Did the referral letter ever make it home? Send home with child along with other important papers, like the report card or a daily communication book Send letter via certified mail Send the letter under that principal’s signature Consult with the student’s teacher (Best way to communicate with the family?) Print on brightly colored paper Call before sending the letter

Strategies for success Get support Communicate with parent/ guardian and staff on the impact of diminished vision on student performance and well-being (newsletters, global calls…) Communicate with parent/ guardian and staff on the impact of diminished vision on student performance and well-being (newsletters, global calls…) Meet with parent/guardian and staff Meet with parent/guardian and staff –Schedule a parent/guardian conference –Participate in Parent/Teacher Conference event Work with the IEP or student assistance team Work with the IEP or student assistance team Engage the student Engage the student Work with the student’s teacher(s), staff, counselor, administration, and outside agencies Work with the student’s teacher(s), staff, counselor, administration, and outside agencies Social worker may be an asset with home visits or connecting with the family Social worker may be an asset with home visits or connecting with the family

Address barriers to care providers –Transportation may need to be provided –Financial needs –Available resources: VSP vouchers member benefit of DSNA/NASN State vision program State vision program Medicaid/Delaware Healthy children’s program Medicaid/Delaware Healthy children’s program Lion’s club Lion’s club

Some activities could actually be the same for multiple measures

Questions ????

Resources Selekman, J.School Nursing: A Comprehensive Text. Philadelphia: F.A. Davis. Selekman, J.School Nursing: A Comprehensive Text. Philadelphia: F.A. Davis Delaware technical assistance manual _schoolnursemanual_b1.pdf _schoolnursemanual_b1.pdf _schoolnursemanual_b1.pdf _schoolnursemanual_b1.pdf The Role of the School Nurse (2011) ports/NASNPositionStatementsFullView/tabid/462/Art icleId/87/Role-of-the-School-Nurse-Revised ports/NASNPositionStatementsFullView/tabid/462/Art icleId/87/Role-of-the-School-Nurse-Revised ports/NASNPositionStatementsFullView/tabid/462/Art icleId/87/Role-of-the-School-Nurse-Revised