No. 37453 (Amendment): Rule R384-201. School-Based Vision Screening for Students in Public Schools

(Amendment)

DAR File No.: 37453
Filed: 03/28/2013 03:42:39 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of school-based vision screening is to set standards and procedures for vision screening for students in public schools. This is necessary to detect vision difficulties in school age children in public schools so that follow-up for potential concerns may be done by the child's parent or guardian. Vision screening is not a substitute for a complete eye exam and vision evaluation by an ophthalmologist or optometrist. The amendment makes minor technical changes to current rule language.

Summary of the rule or change:

This rule establishes guidelines for student vision screening, including screening requirements, documenting proof of screening, training of screeners, screening documentation, and requirements for referrals. The amendment makes minor technical changes to current rule language.

State statutory or constitutional authorization for this rule:

• Section 53A-11-203

Anticipated cost or savings to:

the state budget:

All anticipated costs come out of existing budgets. The Utah Division of the Blind is financially responsible for developing and maintaining a vision screening database, maintaining staff positions for vision screening training, screening documentation, photo screening, and referral follow-up. Staff time is required to process school vision screening reports and to create and maintain a registry of results. The State Department of Health will act as consultant in the development of the database, documentation, training, and visual screening requirements in the school setting.

local governments:

The proposed rule does not add costs to existing local budgets. Existing budgets cover the costs of vision screening in school which have long been established, requiring staff time of school personnel and existing school nurses to participate in training, conduct required screenings, and prepare and submit required reports.

small businesses:

There are no costs for small businesses. The proposed rule only impacts local schools and state government entities.

persons other than small businesses, businesses, or local governmental entities:

There are no costs for small businesses. The proposed rule only impacts local schools and state government entities.

Compliance costs for affected persons:

There are no compliance costs for affected persons. Vision screenings are provided free of charge to students.

Comments by the department head on the fiscal impact the rule may have on businesses:

These changes should have no adverse impact on business.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Disease Control and Prevention, Health Promotion
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Heather Borski at the above address, by phone at 801-538-9998, by FAX at 801-538-9495, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

05/15/2013

This rule may become effective on:

05/22/2013

Authorized by:

David Patton, Executive Director

RULE TEXT

R384. Health, Disease Control andPrevention, Health Promotion.

R384-201. School-Based Vision Screeningfor Students in Public Schools.

R384-201-1. Authority.

(1) This rule is authorized by section53A-11-203.

(2) The Department of Health is authorizedunder the rule to set standards and procedures for vision screeningrequired by this chapter, which shall include a process fornotifying the parent or guardian of a child who fails a visionscreening or is identified as needing follow-up care; and providethe Division with copies of rules, standards, instructions; andrecommendation for test charts necessary for conducting visionscreening.

 

R384-201-2. Definitions.

(1) Division -- Division of Services forthe Blind and Visually Impaired, State Office of Education.

(2) Eye care professional --Ophthalmologist or optometrist

(3) LEA -- Local education agency

(4) Photoscreening -- Automated screeningtechnique that facilitates vision screening in children, especiallythose that are difficult to screen (infants, toddlers, and childrenwith developmental delays). It screens for a range of eye problemsincluding most refractive errors, alignment errors, opacities (suchas cataracts), and other visible eye abnormalities.

(5) Screening certificate -- Writtendocumentation of vision screening or comprehensive eye examinationby a licensed physician, [Ophthalmologist or Optometrist]or eye care professional that have been given within oneyear of entering a public school are acceptable.

(6) Sure Sight -- A vision screeningauto-refractor that identifies nearsightedness, farsightedness,astigmatism and the difference between eyes.

(7) Significant visual impairment -- Avisual impairment [serve]severe enough to interfere with learning. The term is thedesignation required for a child to receive services from districtvision or Utah [School]Schools for the Deaf and Blind (USDB).

(8) Screener -- Pediatricians, familypractitioners, [and ]nurses, or trained medical staff can perform vision screening atregular well child office visits. In addition, school volunteersand groups are trained to support vision screening programs forchildren. A licensed health professional providing vision care toprivate patients may participate as a screener in a school visionscreening program for a child nine years of age or older.

(9) USDB -- Utah [School]Schools for the Deaf and Blind

(10) UDOH -- Utah Department of Health

(11) Vision Screening[ -- Vision screening using an approved eye chart to measurevisual acuity in each eye separately. It is an efficient andcost-effective method to identify children with visual impairmentso that a referral can be made to an appropriate eye careprofessional for further evaluation and treatment.]School Vision Screening programs are an efficient andcost-effective method to identify children with significant visualimpairment so that a referral can be made to an appropriate eyecare professional for further evaluation and treatment. SchoolVision Screenings must use devices and procedures approved by theDivision and UDOH. The procedures for conducting screening mayinclude, age or grade levels to be screened, tests to be used,criteria for referral and documentation of findings.

 

R384-201-3. Purpose.

The purpose of school based visionscreening is to set standards and procedures for vision screeningfor students in public schools. This is necessary to detect visiondifficulties in school age children in public schools so thatfollow-up for potential concerns may be done by the child'sparent or guardian. Vision screening is not a substitute for acomplete eye exam and vision evaluation by an [ophthalmologist or optometrist]eye care professional.

 

R384-201-4. Students Eligible for FreeScreening.

The following students in an LEA mayreceive free vision [screening for distant visual acuity]screenings to include: distance visual acuity and other age appropriate tests that maydetect visual problems upon request.

(1) [Students entering kindergarten and any student under ageeight entering school for the first time in the Utah;]Students entering pre-kindergarten, kindergarten and any studentage eight and under entering school for the first time inUtah;

(2) [Vision screening may be conducted for all school agechildren in grades 1, 2, 3, 5, 7, 9 or 10]Vision screening may be conducted for all school age children ingrades pre-kindergarten through 12. The UDOH and the Divisionrecommend screening students every other year afterpre-kindergarten and kindergarten screenings, to include grades 1,3, 5, 7, and 9 or 10 and annually for students with hearingimpairment and any student referred by school personnel, parent orself to rule out vision as a reason for learning problems;

(3) Tenth grade students may be screenedas part of their driver's education class; and

(4) Students who are currently receivingservices from the Utah Schools for the Deaf and Blind (USDB) or LEA vision staff who havea diagnosed significant visual impairment will be exempt fromscreening.

 

R384-201-5. Required Screening.

Required screening for students identifiedwith disabilities in an LEA are as follows:

(1) Vision issues have to be ruled out asreasons for learning problems before Specific Learning Disabilitycan be used as eligibility criteria and

(2) Every three years, a student must bereevaluated for eligibility for special education in all areas ofsuspected disability, including vision.

 

R384-201-6. Proof of Screening.

Certificate or health form from a licensedphysician, nurse practioner, [Ophthalmologist or Optometrist]eye care professional documenting a visual screening orexamination given within one year of entering a public school areacceptable for school entry. All children [under age 8]age eight and under entering a public school for the firsttime without proof of screening mentioned above, [must]may be screened during that school year by a trained vision screener.

 

R384-201-7. Training of Screeners.

(1) A training session shall be providedby the LEA to all volunteer vision screeners prior to the start ofannual vision screenings.

(2) Trainings in compliance with Divisionmaterials should be provided by the LEA.

(3) The Department of Health incollaboration with the Division shall provide train the trainervision screening training materials.

(4) Training vision screening materialswill be shared with groups that provide free vision screeningservices in Utah schools.

 

R384-201-8. Screening.

(1) Screenings are to be performedfollowing criteria developed by the UDOH in collaboration with theDivision.

(2) It is recommended that visionscreenings are done early in the school session to provide time inthat school year for adequate referral and follow-up to bedone.

(3) Parents/legal guardian of a child havethe right not to participate in vision screening due to personalbeliefs. All parents must be notified of scheduled visionscreenings by the public school to provide an opportunity to optout of screening for their child utilizing the vision screeningexemption form, available at the public school, to document apersonally held belief.

(4) A public school staff member should bepresent at all times during vision screenings performed by anyvolunteer(s) including those done by an [ophthalmologist or optometrist]eye care professional. If the school nurse is not present,the school nurse should be available for consultation andre-screening.

(5) Screenings are to be done usingmaterial and procedures approved by the UDOH in collaboration withthe Division. Standards and procedures are based on guidance ofAmerican Academy of Pediatrics and the American Academy ofOphthalmology and National School Nurse Association.

(6) An [ophthalmologist or optometrist]eye care professional providing vision care to privatepatients may participate as a screener in a free vision screeningprogram for students nine years of age or older.

(a) An [ophthalmologist or optometrist]eye care professional screener may not market, advertise orpromote their business in conjunction with the free screening atpublic school.

(b) The [ophthalmologist or optometrist]eye care professional will provide results of visionscreening to public school [on forms]in a format(paper or electronic) as required by theDivision.

(7) Any group that provides free visionscreening services in the LEA will provide results of visionscreening to the public school on forms required by theDivision.

 

R384-201-9. Documentation andFollow-up.

All vision screening findings are to bedocumented in the student's [school record. Screening follow-up is to be reported to theDivision by the LEA. Reported information may include but notexceed:]permanent school record. Screening failures and follow-upresults for students age eight and under, who are entering schoolfor the first time in this state, are to also be reported to theDivision by the LEA

[Reported information may include but not exceed:]Reported information to the Division shall include:

(1) [Results for Pre-K and Kindergarten students who fail visionscreening and referral to an ophthalmologist or optometrist forfailed vision screening;]The LEA shall report to the division students who fail visionscreening and referral follow-up results for children age eight andunder, who are entering school for the first time in thisstate.

(2) Follow up information from an eyeexamination referral if available may be included with writtenpermission obtained by the public school from the parent orguardian permission;

(3) Follow-up results and screeningfindings are to be documented [on a vision acuity screening referral form]in a format approved by the UDOH in collaboration with theDivision;

(4) Screening results and follow-upinformation shall be sent to the Division on or before June 15 forall screenings performed during that school year;

(5) The Division is responsible tomaintain a state database/registry only accessible by authorizedDivision staff of students who fail vision screening and who arereferred for follow-up.

(6) In the interest of family privacy, theDivision shall not contact a parent or guardian for informationrelated to follow-up referral for professional eye examinationunless assistance is requested in writing by the LEA.

 

R384-201-10. Requirements forReferral.

(1) Children who fail initial ageappropriate school vision screening may be re-screened by a school nurseto confirm results before notification to student's parent orguardian of any impairment disclosed by the vision screeningrecommending further evaluation by an eye care professional. If thescreening of a child 9 or older was administered in the publicschool by an [ophthalmologist or optometrist]eye care professional, the school nurse does not have torescreen.

(2) The public school shall notify, inwriting within 30 days from vision screening, a student'sparent or guardian of any impairment disclosed by the visionscreening recommending further evaluation by an [ophthalmologist or optometrist]eye care professional.

(3) An LEA may provide information to aparent or guardian of availability of follow up vision services forstudents.

(4) A student diagnosed by an [ophthalmologist or optometrist]eye care professional with a significant visual impairmentshall be referred to the LEA vision consultant or teacher of thevisually impaired prior to referral to the USDB.

 

R384-201-11. Photoscreening.

Preschool, kindergarten children, andspecial education students who are not candidates for regularvision screening may be screened by a school nurse using a suresight scanner, another device approved by the Division or by Divisionstaff with a photo screening type device. The Division is available for assistance andconsultation for photo screening. Prior to photo screening by the Division or other outside agencies approved by theDivision, the public school [is required to]shall obtain written permission from the parent orguardian.

References:

National Association of School Nurses(2006) Vision Screening, schools.

S. Proctor (2005) To See or not to Seescreening the Vision of Children in School. National Association ofSchool Nurses.

Pediatrics Vol. 111 No.4 April 2003, pp.902-907 at 2003 American Academy of Pediatrics ICPC-2 CategoryF.Eye.

 

KEY: eye exams, school vision, visionevaluations

Date of Enactment or Last Substantive Amendment: [February 20, ]2013

Authorizing, and Implemented orInterpreted Law: 53A-11-203

 

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