- Auditors discover forgotten follow-ups –

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New York City Comptroller William C. Thompson, Jr. releases an audit finding that the City is failing to screen substantially high numbers of kids for vision and hearing problems on June 19, 2008. Pictured (l to r) are: Rosemary Clemens, Executive Director, New York Children’s Vision Coalition; Dr. A. Norman Haffner, President Emeritus, SUNY State College of Optometry; Dr. Andrea Thau, New York State Optometric Association; Thompson; and, John Graham, Deputy Comptroller for Contracts, Audits and Accountancy. Photo credit: Archer Hutchinson

The New York City Department of Education and the Department of Health and Mental Hygiene are failing to check an astounding number of schoolchildren for hearing and vision problems, according to an audit issued today by New York City Comptroller William C. Thompson, Jr.

The audit - which examined screening and follow-up data in schools in Queens, Manhattan, the Bronx, Brooklyn and Staten Island – found the agencies were dodging regulations and failing to conduct a third of required vision screenings and nearly half of required hearing screenings in the appropriate grades.

“This isn’t just disappointing, but disgraceful,” Thompson said at a news conference. “Poor vision and hearing, if left uncorrected, profoundly and permanently affect a child’s ability to learn, and his or her social development and safety may also be compromised. Data indicates that about a quarter of students need glasses by the time they reach high school. It is simply inexcusable that the City is not providing these vital, mandatory services.”

Thompson’s audit – which can be viewed at www.comptroller.nyc.gov – found that for the period reviewed, only 42% of the Department of Education’s (DOE) required vision screenings and 20% of hearing screenings were conducted. The Department of Health and Mental Hygiene (DOHMH) completed 94% of both vision and hearing screenings over the same time period.

Thompson’s auditors reviewed school years 2002-2003 through 2005-2006, focusing on children who were in the fourth grade during the 2006-2007 school year. When the audit fieldwork began in January 2007, this was the most recent data available.

Noting that the DOHMH had a substantially better record than the DOE, Thompson said: “These results are attributable to a lack of oversight and monitoring of the vision and hearing screening program by DOE, which had no central unit responsible for reviewing screening data during the audited period.”

As a result of DOE’s failure to assign oversight and responsibility for monitoring of the program:

• Vision and hearing screenings are not being provided to New York City public school students in accordance with applicable regulations.
  
  
• There is very limited follow up to parents of students who fail the vision and hearing screenings to ensure that the students who require the greatest amount of follow-up care receive it.
  
  
• DOE cannot ensure that students were screened in the appropriate grades, as defined in the Chancellor’s Regulations, because DOE cannot generate accurate reports on the number of screenings conducted.
  
  
• DOE did not ensure that screenings were conducted at schools that had a School-Based Health Center.

“Children do not receive vision screenings on a regular basis, even though 80% of what one learns in the first 12 years of life is directly connected to ‘seeing,’ ” said Rosemary Clemens, Executive Director of the New York Children’s Vision Coalition, an organization of more than 100 eye and vision care organizations dedicated to ensuring that all children in New York have comprehensive eye and vision care.

“Often they receive no screenings at all,” Clemens added. “When they do the results of a screening seldom make it home, and there is little to no follow-up or effort.  Our mobile vision van visits schools and provides free eye examinations and free glasses when needed. The number of children who need vision care is significant. This situation has gone on for much too long and it should be corrected as soon as possible. We applaud Comptroller Thompson for bringing these issues forward and we will work with his Office as well as continue our  State legislative efforts to foster such changes.”

According to Chancellor’s Regulations, school principals are responsible for the planning and implementation of an individual school health program. The same regulations require vision and hearing screenings to be conducted for students from pre-kindergarten through grade 3, grades 5, 7, and 10, and for new entrants. Vision and hearing screenings also must be provided to special education students, students referred for testing by a teacher, students who have had abnormal tests in the past, and (for hearing only) students at high risk and those returning to school following serious illness.

The agreement between DOE and DOHMH is that DOHMH will screen public school students in kindergarten, first grade and new entrants in elementary schools. DOE is responsible for screening all students not screened by DOHMH and ensuring that all students are screened in compliance with the Chancellor’s Regulations.

All screenings conducted by DOHMH are required to be entered into the DOHMH Automated School Health Record (ASHR) database. All screenings conducted by DOE are required to be entered into the DOE’s Automate the School (ATS) system.

“Early identification, referral, and follow-up intervention are imperative for students who have failed vision and hearing screenings,” Thompson said. “Regardless of which agency conducts the screenings, DOE is ultimately responsible for the vision and hearing screening program and ensuring that all students are screened in compliance with Chancellor’s Regulation A-701. And it is failing miserably.”

Thompson’s audit focused on a sample pool of 297 fourth-grade students from ten different schools across the five boroughs. These students should have received a total of 1,176 vision screenings and 1,176 hearing screenings from kindergarten through third grade. (A complete breakdown of selection methodology can be found in the audit.)

DOE and DOHMH conducted just 776 (66%) of the 1,176 required vision screenings. Only 99 (33%) of the 297 students in the sample received all of their vision screenings. One student was never screened for vision during any of the four school years.


Vision Screenings Conducted at Sampled Schools

With regard to hearing screenings, the two agencies conducted just 639 (54%) of the 1,176 required screenings. Only 31 (10%) of students received all of their required hearing screenings, while four students in the sample were never screened at all.

Hearing Screenings Conducted at Sampled Schools

“Vision problems can sometimes be to blame for low grades, as well as behavior and reading difficulties,” Thompson said. “Similarly, hearing loss can directly affect a child’s ability to develop normal language skills, impairs his or her ability to communicate, and has been shown to correlate with poor academic performance. DOE’s ability to help students who may be suffering from vision or hearing loss has been dismal.”

Thompson made 13 recommendations asking DOE and DOHMH to: immediately take steps to ensure that vision and hearing screenings are conducted for the sample students noted in this report who have not received screenings; and, jointly issue a manual on vision and hearing screening that more clearly defines the division of responsibility between DOHMH and DOE and that reflects the agreement between the agencies on the detailed tasks of their respected staffs.

DOE, meanwhile, should: establish an effective vision and hearing screening oversight unit to monitor screenings and ensure that students are screened for vision and hearing in the appropriate grades, as called for in the Chancellor’s Regulations; require each school to assign individuals to conduct follow-up with parents of all students who fail vision or hearing screenings; and, require an oversight unit to monitor and review screening information entered in ATS to ensure that all school are making the required entries.

In their response, DOE and DOHMH officials generally agreed with seven of the recommendations, partially agreed with one recommendation, and disagreed with the remaining five recommendations.

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