EVAC referral form - svrc.vic.edu.ausvrc.vic.edu.au/downloads/forms/refEVAC.docx · Web viewThe...

1

Eye and Ear on the ParkSt Andrews PlaceEast MelbourneVictoria 3002 AustraliaLocked Bag 8East MelbourneVictoria 8002AustraliaTelephone +61 3 99298666TTY +61 3 99298052Facsimile +61 3 9663 7203Email [email protected]

Statewide Vision Resource CentreEducational Vision Assessment Clinic

PO Box 201Nunawading

Victoria 3131 AustraliaTelephone (03) 9841 0807

Facsimile (03) 9841 0878Email [email protected] or

[email protected]

Educational Vision Assessment Clinic (EVAC)

General Information

Students who have a significant vision loss are eligible to receive additional educational support from the Statewide Vision Resource Centre (SVRC) and Visiting Teachers for Vision Impaired with the Department of Education and Training (DET).

For Students attending an Independent SchoolStudents who are attending independent schools and are vision impaired, established by an appointment at EVAC, are eligible for access to the support and resources of the Statewide Vision Resource Centre.

For Students attending a Catholic SchoolThe Catholic Education Office (Melbourne) provides Visiting Teacher support for children with vision impairments. Children in Catholic schools can also access the support and resources of the Statewide Vision Resource Centre by establishing eligibility through attendance at EVAC.

The purpose of the EVAC is to determine the eligibility to the resources and support of the SVRC and to visiting teacher support-vision.

What is the Education Vision Assessment Clinic?EVAC is the facility which the DET, the Catholic Education Office and Independent Schools use to establish the eligibility of your child to access SVRC and Visiting Teacher support. EVAC is run jointly by DET and the Royal Victorian Eye and Ear Hospital in Melbourne. EVAC is staffed by a multi-disciplinary team of professionals which include a paediatric ophthalmologist and orthoptist employed by the Royal Victorian Eye and Ear Hospital, Education Officers and an Educational Psychologist who are employed by DET.

EVAC assessment comprises two stages, a clinical assessment at the Eye and Ear Hospital and for those children who have a significant vision loss and a functional assessment which will be conducted at the school by an Education Officer.

Prior to attending the EVAC clinic parents are asked to have seen their own ophthalmologist within the past twelve months. Attendance at this Clinic does not replace treatment by the student’s eye specialist.

Statewide Vision Resource Centre PO Box 201 Nunawading 3131 (03) 9841 0242 [email protected] www.svrc.vic.edu.au

http://www.svrc.vic.edu.au/

mailto:[email protected]




http://www.eyeandear.org.au/


2

A student is eligible for SVRC and Visiting Teacher support if the student has sufficiently low vision to be regarded as partially sighted (i.e. distance vision with glasses, if needed, is worse than 6/18 – or its equivalent – and/or a visual field reduction to less than 20 degrees) or is legally blind i.e. distance vision with glasses, if needed, is worse than 6/60 or equivalent and/or a visual field reduction of less than 10 degrees.

There is no cost to either the family or the school for this assessment.

How to apply to EVACIn order for your child to be assessed by EVAC there are several steps. Please complete this application form and sign and the date the consent section on the final page of the Application Form. Please note that without your consent, EVAC is unable to obtain relevant medical reports, assessments and information.

1. The EVAC team, including the paediatric ophthalmologist, will review your child’s ophthalmologist information prior to inviting you to attend a clinical assessment at the Royal Victorian Eye and Ear Hospital.

2. You will be offered an EVAC appointment if your child’s vision, as stated by your ophthalmologist, is significantly reduced.

3. Your child will be asked to attend the EVAC clinic where he/she will be assessed by an orthoptist, and a paediatric ophthalmologist. You will also have the opportunity to meet with an Educational Psychologist and two Education officers. The role of the Psychologist is to assist you in understanding this process and to discuss any educational or behavioural concerns you have regarding your child and their engagement in education. The role of the Education Officers is to observe the clinical assessment, support this assessment with age appropriate suggestions and highlight the educational implications of your child’s vision to those who will be working with him/her in their school environment.

4. At this assessment, if your child’s vision falls within the partially sighted range (acuity of less than 6/18 or a field loss of less than 20 degrees) a functional vision assessment will be completed at your child’s school by one of the Education Officers.

5. A report, with a photograph of your child on it, will generally be sent to you, prior this report being sent to the DET Catholic or Independent (as the case may be) personnel who will be working with your child. This report initiates Visiting Teacher’s involvement. Visiting Teachers working within government schools are employees of the DET. The Catholic Education Office (CEO) employs a team of Visiting Teachers that work in Catholic Schools. Visiting teachers in independent schools are funded by the Association of Independent Schools.

6. You, and any professional you nominate, will get a copy of the clinical assessment report.

What to expect when you come to EVACThe team at EVAC consists of Educators specializing in vision impairment, an Educational Psychologist, who also specializes in the needs of children who are vision impaired, an Orthoptist and a Paediatric Ophthalmologist. We sometimes have ‘Registrars’ (first year ophthalmology students) in attendance who find this clinic very educational and provides them with a wonderful opportunity to learn from unique children.




3

The EVAC team aims to get as much information as possible about your child’s vision and how it is likely to affect them educationally. Tests may include:

acuity on an eye chart by reading or matching letters or pictures reading near print sizes looking at eye movements checking spectacle prescriptions examination of eye health

In order to examine the health of the eye, eye drops usually need to be administered to dilate the pupil. It is helpful to bring a hat and/or sunglasses because this dilation will make your child’s eyes more light sensitive for the remainder of the day.

Because the Educators are involved in these assessments, they can take accurate and current information to the school when they follow up the eligible children. This informs their assessment of the functional vision of the children and forms the basis of their recommendations about adaptations required in schools.

Your child will also be photographed, with your permission, during the functional assessment at school. This photograph will be on the Education Officers functional vision report and will help the Visiting Teacher to identify your child when they attend your school.

The majority of referrals come from the Early Childhood Service of Vision Australia. These children are referred in the year prior to starting in school. We find that approximately one third of these children are found to have vision which has improved to a level which makes them no longer eligible for additional support for vision when they start school. There are several reasons for this. At this stage of their development many children are much better able to respond to tests involving letters or even pictures, and this allows for more reliable and accurate test results. At EVAC, we also try to encourage cooperation and allow children sufficient time to respond reliably to the testing, rather than hurrying them through a clinical test. Also, there are several congenital vision impairments which are known to improve as children get older.

Most students attend the clinic only once, but sometimes review appointments are recommended. For example, vision may have improved to the point where additional support is no longer required. Conversely, if deterioration has occurred, further assessment may be needed to ensure educational support and programming is appropriate.

An assessment from EVAC that a child is ‘ineligible for support’ is good news because it indicates that the child’s vision has improved or their ability to be tested has improved. A child cannot test better than their vision will allow. They can always test worse if they choose not to cooperate, or don’t understand the task.

Eligibility Criteria Eligibility for support is based on the World Health Organisation’s criteria, which defines three ‘ranges’ of vision. All vision assessments are with both eyes open and wearing the best spectacle correction possible. The ‘normal’ range is between 6/6 to 6/18 acuity. The ‘partially sighted’ range is from worse than 6/18 to 6/60. The ‘legally blind’ range is from worse than 6/60 to ‘no light




4

perception’. These categories can also be determined by fields of view, regardless of the acuity. A child with a field of view less than 20 degrees is in the ‘partially sighted’ range. A child with a field of view of less than 10 degrees is considered legally blind.

Children found to be in the partially sighted or legally blind range are eligible for support from the Statewide Vision Resource Centre and Visiting Teacher Support. Children who are legally blind are eligible for both of these supports and also a level of funding. In State Schools this is called PSD (Program for Students with Disabilities) funding. Children who are legally blind are also eligible for a ‘Blind Pension’ when they turn 16 years.

Regardless of the outcome at the EVAC assessment, the Education Officers will make contact with the child’s school to explain the outcomes at the EVAC clinic and discuss the implications and concerns about how your child will cope at school.

The EVAC Clinic is situated at:The Royal Victorian Eye and Ear Hospital On the Park, Smorgon Family BuildingGround FloorReception ASt Andrews Place East Melbourne

Entrance via car park in Lansdowne Street or main building (yellow doors) in St Andrews Place.

EVAC is conducted on a Wednesday morning.

All referrals to this Clinic should be addressed to:

Ms Deb Davidson or Ms Annette Godfrey-MageeEducation Officers for Vision Impairment (EVAC)

P.O. Box 201NUNAWADING Victoria 3131

Contact details:Telephone: 9841 0807. Fax: 9841 0878.

Email:[email protected]>

[email protected]

Please do not hesitate to contact Deb Davidson (0438 681 907) or Annette Godfrey-Magee (0419 157 748) 9841 0807 if you require any further information regarding the clinic and its operations.






5

The Royal Victorian Eye and Ear Hospital on the ParkSt Andrews PlaceEast MelbourneVictoria 3002 AustraliaLocked Bag 8East MelbourneVictoria 8002AustraliaTelephone +61 3 99298666TTY +61 3 99298052Facsimile +61 3 9663 7203Email [email protected]

Statewide Vision Resource CentreEducational Vision Assessment Clinic

PO Box 201Nunawading

Victoria 3131 AustraliaTelephone (03) 9841 0807

Facsimile (03) 9841 0878Email: [email protected] or

[email protected]

Educational Vision Assessment Clinic (EVAC)

Application Form

The EVAC is the facility the Department of Education and Training uses to establish eligibility to the support and resources of the Statewide Vision Resource Centre (SVRC) and Visiting Teaching Support (Vision). Children who have a significant vision loss are eligible for these supports. A student is eligible for additional educational support if the student has sufficiently low vision to be regarded as partially sighted i.e. distance vision with glasses, if needed, is worse than 6/18 – or its equivalent – and/or a visual field reduction to less than 20 degrees or is legally blind i.e. distance vision with glasses that is worse than 6/60 and/or field loss of less than 10 degrees (Please see attached information)

The purpose of this form is to:

Provide your consent to the EVAC team assessing your child for the purpose of providing support and resources from the Statewide Vision Resource Centre and Visiting Teacher support to both your child and his/her school.

Give permission for the EVAC team to collect information from your child’s treating ophthalmologist.

Give permission for the EVAC team to gather and share personal, school and medical details for the purpose of providing SVRC and Visiting Teacher supports.

I would like to be sent information on: (please tick box/es)

Better Start for Children with Disability funding

Guide Dogs Victoria – Children’s Mobility Service

Insight Education Centre for the Blind and Vision Impaired

Vision Australia Children’s Services







http://www.eyeandear.org.au/


6

Date of Referral:

Patient/Student Details

Surname Given Names

Date of Birth

Male Female Address

Country of Birth

Preferred Spoken Language

Is an Interpreter required at your Clinic visits? Yes No

Aboriginal or Torres Strait Islander Status:

Not Aboriginal or Torres Strait Islander

Aboriginal, not Torres Strait Islander

Aboriginal and Torres Strait Islander

Torres Strait Islander, not Aboriginal

Medicare Card No Expiry date

Position on Card

Health Care Card No Expiry date

Pension Card Number Expiry date

Parent/Guardian/Carer Contact Details

Surname Given Names

Address

Telephone (H) (W)

(Mobile)

Email

Relationship to Patient




7

Other Parent/Guardian/Carer Contact Details (optional)

Surname Given Names

Address

Telephone (H) (W)

Mobile

Email

Relationship to Patient

School Details

School (or proposed school)

Year Level

Address

Name of Principal

Contact Person

Telephone

Other Relevant Personnel at school

Local Doctor or GP Details

Following the EVAC assessment a report from this appointment will be sent to your GP.

Name of Doctor

Clinic Name

Address

Telephone Fax

Permission for the EVAC team to contact and share information: Yes No




8

Ophthalmologist

Following the EVAC assessment a report from this appointment will be sent to your ophthalmologist or relevant hospital department. (If an ophthalmologist has not been seen in the last twelve months, this should be arranged prior to referral)

Permission for the EVAC team to contact and share information: Yes No Name of Ophthalmologist

Clinic Name

Address

Telephone Fax

Other Professionals working with your child

ReportsFollowing the EVAC assessment a report from this appointment will be sent to any practitioner or hospital department you nominate to receive this information.

Name of Paediatrician

Clinic Name

Address

Telephone Fax


Name and Role of Other Professional

Clinic Name

Address

Telephone Fax


Other Agencies working with your child (e.g. Guide Dogs Victoria, Vision Australia, Insight)




9

Name or Organisation

Contact Person

Address

Telephone Fax

Permission for the EVAC team to contact and share information: Yes No Referral Details

Referred by

Address

Telephone Mobile

Date of Referral

Reason for Referral: To assess eligibility for access to the resources of the SVRC and Visiting Teacher Service.

Signature of person referring

Please print name




10

Consent

The Royal Victorian Eye and Ear HospitalConsent for Information ReleaseI understand it is the usual practice of the Hospital to release information in my medical record to my treating doctors and General Practitioner. The Hospital will also forward anonymous information to The Department of Human Services for statistical purposes. In ordinary circumstances no other information in my medical record will be released to a third party without my consent.

Signature of patient/guardian

Please print name

Date

Department of Education and TrainingPERMISSION TO COLLECT, USE AND DISCLOSE INFORMATIONI consent to the Department of Education and Training, collecting, using and disclosing information to:

Establish the eligibility of my child to access the resources and support of the Statewide Vision Resource Centre and Visiting Teacher support, and

If my child is assessed as eligible, for the Education Officer to complete a functional assessment at my child’s school and provide the school and Departmental Regional staff with a written report that identifies the educational implications of my child’s vision impairment.

To discuss EVAC’s assessments and outcomes with school staff, the visiting teacher and DET Regional Personnel to identify and make relevant adjustments to my child’s educational program.

I confirm the following:

I have received, read and understood the general information and privacy information provided with this form.

I understand how my/my child’s personal information and health information (vision) will be collected, received, used and disclosed.

I consent to the Department of Education and Training (DET) photographing my child for the purpose of identification and administration of EVAC reports and case files.

I understand I may withdraw my consent for DET to collect, use and disclose information as stated in this application at any time.

I understand that without my consent, DET is unable to assess my child’s eligibility for access to SVRC resources and Visiting Teacher support.

Signature of patient/guardian

Please print name

Date




11

Department of Education and TrainingImportant Privacy Information

The Department of Education and Training (DET) values the privacy of every individual and is committed to protecting all personal and health information collected. In Victoria, the laws that set privacy requirements are the Health Records Act 2001 and the Privacy and Data Protection Act 2014. These laws set out what we must do when we collect, use, handle and destroy personal and health information when we provide a health service, such as the services provided by the staff members of the Educational Vision Assessment Clinic (EVAC) that are employed by DET.

The Health Records Act is most relevant to the services provided by DET through EVAC and it says:Personal information is information or an opinion (including information or an opinion which is on a database), whether true or not, and whether recorded in a material form or not, about an individual whose identity is apparent, or can reasonably be ascertained from the information or opinion. Health information is information or an opinion about the physical, mental or psychological health of a person, the disability of a person; a person’s expressed wishes about the provision of services to him or her, which is also personal information. Health information includes other personal information that is collected to provide, or in providing, a health service such as services provided by DET through EVAC.

Collection of personal and health information by DET through EVAC DET collects information through EVAC for the purpose of assessing the eligibility of your child to access SVRC resources and Visiting Teacher support. DET also collects information through EVAC for the purpose of providing information to schools and Department Regional personnel who coordinate these supports for your child.

In order to assess your child’s eligibility, we collect information through this Educational Vision Assessment Clinic Application Form and through conducting a functional assessment of your child. We also collect medical reports, assessments and other relevant information, ophthalmologist and other professionals working with your child.

EVAC staff employed by DET also photograph your child for the purpose of identification and administration of its reports and case files. This occurs during the functional assessment.

Use and disclosure of personal and health information by DET through EVACFor the purposes of assessing eligibility we use and/or disclose information as follows:

EVAC staff employed by DET discuss personal information and health information with EVAC staff that are employed by the Royal Victorian Eye and Ear Hospital the for the purpose of assessing your child’s eligibility.

For government schools, copies of your child’s functional and clinical reports are sent to the team leader of the Visiting Teacher Service in each region. For Catholic School they are sent to the individual Visiting Teacher and for Independent schools these reports are sent directly to the school. The clinical reports provide evidence of eligibility to access DET supports and to provide relevant information for Visiting Teacher programming intervention. The functional report will have a summary and explanation of the clinical findings.

We discuss both the clinical and functional findings with the visiting teacher and/or DET regional personnel for the purpose of identifying educational programs and adjustments to your child’s program. Please note that in Victoria, registered schools are either government, independent or Catholic. Government schools are a part of DET, Independent and Catholic schools are separate and independent legal entities to DET.If health information is disclosed to school staff, they are required to comply with the Health Records Act 2001.If personal information is disclosed to school staff, they are required to comply with the Privacy and Data Protection Act 2014 (or the Privacy Act 1988 (Cth) where relevant).

Disclosure or use will otherwise only occur if permitted by law. In some instances DET may be compelled by other laws to disclose information held about your child to other bodies such as a regulatory agency, law enforcement agency, court or tribunal.

Accessing personal and health information.Your child or their authorised representatives (e.g. parent and guardian or carer) can access the personal and medical information held by DET.

Please note that Information from your child’s medical file is held by the Eye and Ear Hospital. An application to access your child’s educational file can be made via an email to the Information Management Division of DET on [email protected].

Withdrawing ConsentConsent to EVAC staff employed by DET collecting, using and disclosing person and health information may be withdrawn at any time by writing to Marion Blazé or Annette Godfrey-Magee. Before withdrawing consent we recommend first discussing your decision with either Marion or Annette.Withdrawing consent means that DET will not be able to assess and /or provide support from SVRC and Visiting Teachers to your child and his/her school. For more information please contact Marion Blazé 0409 860 251 or Annette Godfrey-Magee 0419 157 748. Office: 9841 0807





EVAC referral form - svrc.vic.edu.ausvrc.vic.edu.au/downloads/forms/refEVAC.docx · Web viewThe...

Documents

Transcript of EVAC referral form - svrc.vic.edu.ausvrc.vic.edu.au/downloads/forms/refEVAC.docx · Web viewThe...