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Eye Health Conference17th September 2014

Heather Payne, Paediatrican, Subgroup ChairRebecca John, Clinical Lead, Low Vision Serviceheather.payne@wales.gsi.gov.uk

Vision for Children -the work of the Children’s Eye Health subgroup

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Children’s Rights to vision

• Play• Learn• Be resilient• Have good health• Make friends• Feel safe• Not be disadvantaged

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Children’s Subgroup

Aims:

• Prevention

• Early intervention

• Effective, accessible services

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School Pupil Eye Care Subgroup (SPECS)

• Chaired by Minister

• 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• 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:• 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• 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)

Appointment made through central administration team.

(S+A)

History and symptoms (O/DO/S)

Special school team attend and perform eye examination on school

premises, GOS 1/6* (O+DO)

No pathology or refractive error found

Refractive correction required Pathology identifiedNeed of Low vision

appointment identified. Referral to relevant

professional. (O) Voucher GOS 3 issued at school

(O) **

Frame selection, fit and dispense at school (O/DO)

Voucher GOS 3 issued for

patient (P) **

Practitioner returns to school for final frame

fitting. (DO)

Frame selection, fit

and dispense at optometric

practice. (P/Comm O)

BV problem identified

Reception age/transition pupils.

Full orthoptic assessment (OR)

Recall period set and report written for

parent and school. (O)

Low Vision Assessment performed within

school setting. (O/DO)

Management within school (OR)

Special Schools Vision Service Draft Patient Pathway.

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.

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Conclusions:

References