Transcript Special Schools Eye Care Pilot 2013-2014

Corporate slide master
Vision for Children
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-the work of the orate presentations
-the work of the Children’s Eye Health subgroup
Eye Health Conference
17th September 2014
Heather Payne, Paediatrican, Subgroup Chair
Rebecca John, Clinical Lead, Low Vision Service
[email protected]
Children’s Rights to vision
• Play
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• Learn
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• Be-the
resilient
work of the orate presentations
• Have good health
• Make friends
• Feel safe
• Not be disadvantaged
Children’s Subgroup
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-the work of the orate presentations
Aims:
• Prevention
• Early intervention
• Effective, accessible services
School Pupil Eye Care Subgroup
(SPECS)
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-the work of the orate presentations
• Includes all delivery partners
• Newborn eye screening
• School entry screening
• Special Schools Project
Special Schools Eye Care
Pilot 2013-2014
Rebecca John
What is a Special School?
‘An educational establishment specifically resourced to meet the needs
of the most complex and challenging young people in communities.
Typically they will provide an environment for the delivery of education
as ell as social and health needs’
(Welsh Assembly Government 2005:The National Service Framework
for Children, Young People and Maternity Service in Wales. )
Background
• Vision screening should be carried out on all children aged 4-5 years.
• A full eye examination should be performed on children of any age
with suspected visual defects, a significant family history or any
neurological or disabling condition. Reword (Hall and Elliman, 2008)Hall report
• Children in special schools are at greater risk of refractive error and /
or visual impairment (A Clear Vision June 2012)
However;
• Special schools are not necessarily included in the funding for school
vision screening (Pilling 2011)
‘A Clear Vision’ June 2012
• In 2012 a research project took place
to look at the provision of Eye care in
the Special School environment
within Wales to determine whether
eye tests should be made available in
special schools.
• Should eye care be provided
for children within the special
school environment?
Barriers to High Street Care
• Access- wheel chairs, travel, parents, carers
• Unfamiliar settings
• Time constraints of routine appointments
• Multiple health appointments
• Poor communication
• Challenging behaviour
Advantages of a school based service
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•
•
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A familiar environment for students.
No long, uncomfortable journey involved.
Parents do not have to be present.
Support and knowledge of teachers, nurses and
care givers.
• Ability to raise awareness of the educating and
care staff regarding the importance of spectacle
wear, effect of vision impairments and provisions
which may need to be made.
• A similar dental service does exist for
special schools
School name
Location
Age
(years)
Number of pupils on roll
Maesgwyn School
Aberdare
11-19
102
Ysgol Heulfan Y Canol
Wrexham
3-16
28
Crownbridge School
Pontypool
2-19
80
St.Christopher's School
Wrexham
6-19
240
Portfield School
Haverfordwest 3-19
108
TOTAL
558
Key findings
• One in five pupils have a visual impairment which is likely to impact
on their education. However, only 6% of pupils a visual impairment
recorded in their statement of Special Educational Needs.
• Over 50% of the children needed spectacles while only 30% had
previously had them prescribed. Only 15% were still wearing them.
• At least one fifth of the pupils with low vision could have normal
vision with spectacles.
Recommendations
• An optometric service should be provided to
pupils in special schools.
• A transitional service should be established to
support pupils in special schools become familiar
with having sight tests in community practice
A Pilot is born
• Special schools Eye Care Pilot
project
• December 2013- July 2014
• Pilot Members:
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•
•
•
Maggie Woodhouse- Advisor
Rebecca John- Clinical Lead
Aideen McAvinchey- Optometrist
SPECS group.
School Pupil Eye Care Services (SPECS)
• A sub group of the ‘Children’s Vision Service Advisory Group
• Members representation
• Welsh Government• Chief Optometric Advisor Welsh Government
• Head of Eye Care policy Welsh Government
• Children’s vision advisory group
• Optometry Wales
• RNIB
• LVSW
• PHW
• Education
• Health board
• Chaired by Mark Drakeford- Minister for Health, Welsh
Government
• Role: To advise the Children’s Group on Pupil Eye Care Services.
Considerations
• How the service would work
• Staff needed and job roles
• Responsibilities of the service
• Responsibilities of the school
• Equipment needed.
• Resources at school needed.
• Education. Staff, children,
parents/carers
• Inclusion of LVSW
The Role of the pilot
• Continued care to patients seen in the research project.
• New care to other children in the research project schools
• Identification of whether it is practical to provide an optometric service
within special schools.
• How that service would work.
• The difficulties that would be encountered.
• Patient eye care pathways.
• Staff, facilities, equipment and training that would be required.
• How the service would function financially and any barriers which may
exist such as current legislation.
Pilot vs Research project
• Consent levels increased by 11%-68%
• In 2 of the schools there was 100%
consent
• Encouraged by teachers who had seen a
positive outcome following the research
project
• Of those dispensed in the research
project, the rates of children still
wearing spectacles ranged from 20%67% compared to 15% previously.
• Spare pairs
• Awareness of teachers of need
Other Factors
• Not all those who consented for a sight test were able to be tested
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•
•
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Refusing to leave the classroom
Running away and hiding when moving from classroom to test room.
Violence during the test
Verbal threats during the test
• Not all those identified as needing glasses were dispensed.
• Physical aggression (teachers needing to hold children down)
• Self harming (glasses seen as another tool for self harm)
• At request of parents/school
Difficulties Encountered
• Time spent phoning parents and guardians for
history and symptoms
• Chaperone not always being available so unable to
perform the test
• Room allocation• Time consuming administration.
• Teacher and support team advice
• Finding the children.
• The majority of these difficulties will be solved
by the proposed model for the Special Schools
Vision Service for Wales.
What a All Wales Special School Vision Service
looks like.
• Optometrists, dispensing opticians and orthoptists.
• Central administration team
• Suitable rooms
• Equipment
• Training
• Run along side LVSW
• Transition
Obtain positive Consent
(S+A)
Special Schools
Vision Service Draft
Patient Pathway.
Appointment made through
central administration team.
(S+A)
History and symptoms
(O/DO/S)
Reception
age/transition pupils.
Special school team attend and
perform eye examination on school
premises, GOS 1/6* (O+DO)
Refractive correction required
Voucher GOS 3
issued at school
(O) **
Frame selection,
fit and dispense
at school (O/DO)
No pathology or refractive
error found
Referral to relevant
professional. (O)
Voucher GOS
3 issued for
patient (P) **
Frame
selection, fit
and dispense at
optometric
practice.
(P/Comm O)
Practitioner returns to
school for final frame
fitting. (DO)
Pathology identified
Need of Low vision
appointment
identified.
Low Vision Assessment
performed within
school setting. (O/DO)
Recall period set and
report written for
parent and school. (O)
BV problem
identified
Full orthoptic assessment
(OR)
Management within
school (OR)
What happens next
• Full pilot year report.
• Health boards and education on board
• Funding
• Change in legislation
• Eye health care delivery plan has set ‘more children having sight tests
in special schools’ as one of its outcomes.
School Feedback
I am pleased to give you feedback from a schools point of view regarding the Low Vision Service Wales
initiative.
Testing eye sight in school has made a remarkable difference within our school.
I must admit at the start of the process I thought the time taken within school would limit the learning
opportunities and cause disruption for the children. However the opposite has happened. The service
has been delivered in an extremely professional manner with little or no disruption in school.
Parents, carers and the teaching staff are delighted with the service. Of course the teachers are
delighted that pupils needing glasses are able to have them when in fact parents at home may not of
even bothered.
This service has been exceptional our recent Estyn Inspection highlighted our school as Excellent with
the view that our collaboration with services was outstanding. The Low Vision Service was one of the
services that they were impressed with during their visit.
I hope now this service is able to continue.
Conclusions:
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References