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
impacts the student’s ability to learn
• 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:
Vision and Hearing Screening
2.1.1 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.
2.1.1.1 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.
2.1.1.1.1 Driver education students shall have a vision screening within a year
prior to their in car driving hours.
2.1.2 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.
New enterers
Those being considered for special education
Teacher referrals
Driver education students shall have a vision
screening within a year prior to their in car
driving hours.
Mandated hearing screenings
• 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
• Those being considered for special
education
• Teacher referrals
What type of tests should be used?
• First time screening
• Routine screenings
• Referral criteria
How to choose a cohort:
• Include the entire school and should not
be broken into smaller cohorts
• Screening Completion Rate from previous
year compared to current year
• There must be a minimum of 10 students
referred in the previous year
How to get a baseline
• Cognos Report
Standard DOE Public Reports > Medical
Reports > Annual Reports > Incomplete
Referrals Current
• Consider using percentage of a
comparable cohort of schools
Calculate the baseline
• Determine the Vision Screening Referral
Completion
• Divide the Number of Completions by the
Number of Referrals to determine the
percentage of Completions.
Do the math…..
# of Completions = percentage complete
Total # referred
Example:
25 complete = .50 (50%)
50 referred
How to calculate the growth
FY12 State Hearing Screening Referral Completion Rates
STATEWIDE:
53%
GRADES PreK – 2:
53%
GRADES 3 – 5:
38%
GRADES 6 – 8:
21%
GRADES 9 – 12:
46%
FY12 State Vision Screening Referral Completion Rates
STATEWIDE:
38%
GRADES PreK – 2:
42%
GRADES 3 – 5:
34%
GRADES 6 – 8:
29%
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)
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 #1
40%
60%
(state)
- 20%
10%
50%
School #2
75%
60%
+15%
0
75%
School #3
50%
42%
(district)
85%
(state)
*
-35%
17.5%
67.5%
n/a
n/a
42% - 5%
= 38% **
School #4
(new nurse)
No data
42%
(nurse (district)
was not
85%
in a
(state)
school)
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
• 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 noncompletion
Review Documentation
•
•
•
•
•
•
What codes to use (Is the coding correct?)
Document better in the future
So you can use the data next year
Were all REFERRAL Completions?
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.
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…)
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
• Engage the student
• 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
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
Medicaid/Delaware Healthy children’s
program
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.
• www.nasn.org
• http://nasn.org/ToolsResources/Vision
Delaware technical assistance manual
• http://www.doe.k12.de.us/infosuites/schools/files/de
_schoolnursemanual_b1.pdf
The Role of the School Nurse (2011)
http://nasn.org/PolicyAdvocacy/PositionPapersandRe
ports/NASNPositionStatementsFullView/tabid/462/Art
icleId/87/Role-of-the-School-Nurse-Revised-2011
• www.dsna.org