Voices From the Field: Interview with P. Kay Nottingham Chaplin

Vision and Eye Health for Young Children
Kay Nottingham Chaplin

Kay Nottingham Chaplin, Ed.D., is the Education and Outreach Coordinator for Prevent Blindness, working primarily with its National Center for Children’s Vision and Eye Health. She provides technical assistance about all aspects of a vision and eye health program, including early detection through screening and program evaluation and improvement. Dr. Nottingham Chaplin has worked in vision screening for 21 years. She assisted states in creating or revising vision screening and eye health guidelines, and serves as a panelist or presenter at webinars and lectures at international and national venues.

How did you begin your career in early childhood?

My first career was as a newspaper reporter, columnist, and editor. I found myself gravitating toward medical writing. Somewhere along the line I developed an after-school program and created the curricula for a childcare center. From there I moved to directing an early intervention birth-to-three program. I asked a pediatric ophthalmologist to help me create a vision screening tool for infants and toddlers in our program. I was hired to help create and direct the program and serve as the primary trainer. We trained school nurses, Head Start staff, and medical practice personnel to screen the vision of children with evidence-based tools and best-practice procedures. After doing consulting work, I found a new home for my skill set at Prevent Blindness and its National Center for Children’s Vision and Eye Health (NCCVEH), where I provide training that enables thousands and thousands of children to have the best vision possible. This includes one of my two granddaughters, who recently, at age 3 ½ years, was diagnosed with high hyperopia and strabismus.

What efforts have you been involved in to improve the quality of early childhood programs and services?

I assist states and school districts in creating or revising their vision and eye health guidelines to ensure that age-appropriate and evidence-based screenings are conducted, and that best practices are used to identify vision issues early and connect children to care, no matter their family’s circumstances or zip code. An association exists between vision and learning. We want to ensure children have their best possible vision to help them achieve their best possible academic outcomes. Vision screening, however, is only one part of a 12-Component Strong Vision Health System of Care, which I helped to create. The NCCVEH worked with the National Association of School Nurses to create a “Vision and Eye Health” webpage for school nurses based on the 12 Components. The first component involves parent education about the importance of vision screening and the confirmation eye examination with treatment and/or monitoring for ongoing eye care. Much of the literature points to the need for parent education about their child’s vision. For parents and caregivers, we created the “Small Steps for Big Vision: An Eye Health Information Tool Kit for Parents and Caregivers” in English and Spanish, which includes information about the importance of the best vision possible and signs and symptoms of possible vision disorders. Another component involves helping parents and caregivers arrange and attend a confirmation eye examination when their children receive vision screening referrals. Small Steps provides information about the relationship between poor vision and academics, the relationship between poor vision and classroom behaviors, how to schedule an eye examination, questions to ask the eye care provider, and financial assistance for an eye examination and prescription glasses, if needed. The overarching goal of the Small Steps program is to help reduce the gap between vision screening referrals and follow-up to an eye examination. For the vision screening component of a strong vision health system of care we created a “Vision Screening Guidelines by Age” webpage for evidence-based tools to use with children at different ages, which includes a vision screening tool for infants from birth to the 1st birthday and a poster for parents to monitor the key vision development milestones of their children between birth and baby’s first birthday.

What are some of the challenges you have experienced in your work and what strategies have you tried to overcome them?

The literature suggests that vision screeners should receive official training in screening vision. One challenge involves vision screeners who do not receive official training in evidence-based tools and best practices and unknowingly and unintentionally use inappropriate screening tools and methods that could result in the under- or over-referral of children for eye care. Our strategy is to provide webinars and lectures. Conducting evidence-based vision screening is insufficient, however, if referrals do not lead to eye examinations and ongoing care. Thus, a primary national challenge is to reduce the gap between vision screening referrals and complete eye examinations. We want families to understand that, although they may think eyeglasses are unnecessary, those glasses will help their children socially and academically. Too often, the eye examination does not occur. Our strategy is to create a technique to help vision screeners dig deeper into attitudes, cultural beliefs, and perceptions that prevent families from getting eye examinations and to help provide solutions.

What suggestions do you have for others interested in improving early childhood services and programs?

One suggestion includes knowing the signs and symptoms of possible vision disorders and requesting an eye examination. A second suggestion is to change mindsets about the association of vision with certain child behaviors. For example, if a child is having difficulty participating in classroom activities, please think of vision. If a child is struggling with learning to read, think of vision. If a child is squinting during classroom activities, think of vision. If a child is running around the room during circle time, think of vision. A third suggestion is to ensure vision and eye health programs follow the 12 Components of a Strong Vision Health System of Care. A fourth suggestion is to ensure vision screeners receive training and certification, conduct consistent vision screening activities using age-appropriate and evidence-based tools, and follow best practices. A final suggestion is to know that undiagnosed and untreated vision problems early in a child’s life can lead to permanent vision loss.

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