Promoting Equity in Children’s Vision Health
Cindy Hillyer is the director of the Office of Early Childhood Education at Minneapolis Public Schools. Throughout her career, Cindy has led public health and education initiatives focused on cross sector collaboration and advancing equity. She currently serves on the University of Minnesota Institute on Community Integration Advisory Board; the Executive Committee of the City of Minneapolis Child Friendly City Initiative and chairs the Minnesota Early Childhood Vision Health Task Force-a National Center for Children’s Vision and Eye Health-Better Vision Together team.
ED: How did you begin your career in early childhood?
I attended nursing school at the University of Minnesota School of Nursing and I began my career working for Catholic Charities as an intake nurse at St. Joseph’s Home for Children in Minneapolis, Minnesota. St. Joe’s was the first stop when county child welfare was involved with a family and their children were placed temporarily in foster care. This first career experience influenced my interest in working to support families and young children to avoid out-of-home placement when possible. This led me to work in the public health field for 20 years. I worked as a visiting nurse, providing home visits to young moms and their children. I then managed local early childhood public health programs. For the last 12 years, I have worked in education and currently serve as director, Office of Early Childhood Education in Minneapolis Public Schools (MPS). In this role, I oversee Early Intervention Central Intake and Early Childhood Screening (ECS). ECS is a unique Minnesota program that provides a universal, required health and education screening touch point for 3- through 5-year olds before kindergarten and includes a vision health screening. Working in several jurisdictions, including city and county government and now public schools, has given me the opportunity to develop a unique expertise in cross-sector and cross jurisdiction collaboration aimed at improving program quality, family engagement and timely access to services to advance health and education equity for underserved populations.
ED: What efforts have you been involved in to improve the quality of early childhood programs and services?
An equity strategy that I am currently leading is focused on improving the vision health of young children in Minneapolis, especially children of color, Native American and new immigrant children. The strategy aimed to increase early detection of vision problems and access to exams and treatment for positive screens. Employing a technology-based instrument vision screener in place of a manually administered wall chart vision screening the MPS ECS program realized a 483% annual increase in early detection of vision problems, primarily for underserved populations. The technology screener mitigates language barriers and rely less on the testing environment for a reliable screening result. While serving the same overall number of children, through instrument screening and effective follow up, the program moved from 35 children receiving glasses to 169 children receiving glasses during the school year.
Keys to the success of advancing vision health in Minneapolis include using a framework for improvement that supports effective internal processes and external collaboration. Because of the interest in spreading best practices, MPS convened a group of local stakeholders to develop a comprehensive vision health plan to scale best practices, develop a policy agenda and align resources to advance vision health of children in Minneapolis. Minneapolis Vision Health Task Force stakeholders include MPS, City of Minneapolis Health Department and Youth Coordinating Board, Hennepin County Child & Teen Checkups, MN Departments of Health and Education, Hennepin Healthcare, MN Children’s, the MD5M Kids Sight Foundation (Lions Clubs International), University of Minnesota, Center for Leadership in Maternal and Child Public Health, Parents In Community Action Head Start and Early Head Start and Allina Health Phillips Eye Institute Early Youth Eye Care Community Initiative.
One of the first actions of the Minneapolis task force was to submit an application to the National Center for Children’s Vision and Eye Health Better Vision Together Community of Practice initiative aimed at developing a model comprehensive system of early childhood vision health care. The Minneapolis team is one of seven teams from around the country participating and learning from each other in the Better Vision Together Community of Practice.
ED: What are some of the challenges you have experienced in your work and what strategies have you tried to overcome them?
There are several challenges to making systems change happen. In order for large scale, lasting change I have learned that the following are essential: collaborating across organization and sectors, engaging parents, aligning strategy and resources and effective leadership. The key strategy to parent engagement and a key challenge in the work is hiring a diverse team that reflects the ethnic and language diversity of the population served. It is essential to hire staff that reflect the population as a way to develop service models that have cultural resonance and effective communication strategies with families. In order to hire an adequately diverse team I find it useful to analyze population demographics to assure that that the percentage of staff hired reflect the number served by population group.
Another challenge is a consistent practice of care coordination or following up with the family after screening to assure the child has access to an eye exam and treatment. In Minneapolis, we are aligning resources across health, education and public-nonprofit sectors to assure that children receive the care that they need. MPS, the Phillips Eye Institute, Hennepin County Child & Teen Checkups and the MD5M Kids Sight Foundation are collaborating to coordinate screening and follow up efforts on positive screens to leverage improved access to care to improve the population’s eye health.
Lastly, creating an aligned policy agenda can be a challenge due to philosophical differences and competing organizational priorities and aligning rural and urban needs. The key to successfully navigating these challenges is to build a diverse coalition, develop strategy alignment, intentionally build trust and generously share credit for successes.
ED: What suggestions do you have for others interested in improving early childhood services and programs?
Finding common ground and alignment in strategy, direct service priorities and data measures across sectors and organizations are keys to improving program services and population outcomes. The commonalities in the vision health work included tracking overall number of children screened, positive screens, age at screening and ethnicity of children. Converging data from all organizations supported the efforts of the Minneapolis vision health work, providing a clearer picture of gaps in services.
Focus on developing a continuous improvement mindset at both the program and coalition level. Decide on an improvement framework and use it. The Minneapolis Vision Health Task Force developed a driver diagram that included a population aim, key drivers and tests of change ideas. This documents still guides our work as we continue to improve. When we try a change idea and it works, we move to implementation. If it does not work, we set it aside. Trying ideas and formalizing the ones that work into a plan saves time, money and builds buy in among stakeholders. Over planning before testing can be defeating when the long-planned idea does not test well.
Frame your improvement work around equity from the start. This will focus your quality improvement strategy on meeting the needs of all population groups in the community and particularly the underserved. One strategy we use at MPS ECS to assure that we are meeting needs of all groups equitably is to annually survey parents from diverse backgrounds about what services are best supporting their family and child and what is missing or needs improving. We analyze the data by group and make adaptations to services to better support all groups in the community. The survey includes questions about MPS program services and access to other services in the community. Program staff, who reflect the population do survey administration, analyze results with leadership and design program changes.
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