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2015 KidSight Packet Lions KidSight USASaving Kids’ Sight25 Million Kids Need You, So Get Involved Today! The purpose of this packet is for general informational purposes only. If there are any questions, please contact your District Director or consult the website below. and General Information pg. 3Who Can I Contact for Help? pg. 4The Impact: Corey’s Story pg. 5How Can I Fundraise for KidSight? pg. 6 - 7How Do I Use a Vision Screener? pg. 8 - 10Reporting Forms pg. 11 - 14Background and General InformationWhat is Lions KidSight USA???????? Lions KidSight USA is a nationwide program set forth by Lions Club International (LCI) with the goal to safeguard the vision of children aged 6 months through 6 years. According to educational research, 80% of learning is visual. Healthy vision is imperative for a child to go through healthy development. Most children don’t get screened for vision until they notice a problem or a problem is detected in school. Kidsight is a proactive approach to screening children before it is too late. Unless vision problems are detected early, they risk becoming permanent by age 7.The mission of KidSight is to ensure eye screening and follow-up care is given to all children between 6 months through 6 years because every child deserves to learn and see the world clearly. To do this, Lions will work to increase the number of screening programs around the country in order to reach more children.How Lions can help: Lions Clubs can conduct vision screenings in their community to target children in this age range. Clubs who do not have a screening device can rent one through the Georgia Lions Lighthouse Foundation (GLLF). MD-18 Lions Clubs should first contact their District Director to make them aware of your desired efforts. Next, a Lions club should contact the Department of Public Health to research what screening efforts are already in place and need bolstering. Lions Clubs can also contact Pre-K Institutions, Head Start programs, community health clinics and organizations, health fairs, and elementary school nurses in their local communities. It is vital to have a HIPPA compliant system in place before any child is screened. A HIPPA compliant permission form must be signed by parents and a document sharing the screening results must be made to share with parents. Forms are included at the end of this packet. If additional screening forms are needed, please contact your District Director. Once conducting the screening, it is imperative that the Club maintains a list of screening information including the number of children screened and those referred for an exam. This screening information should be sent to both your District Director and GLLF. This is to provide accurate reporting to LCI.The GLLF is able to provide comprehensive vision services and glasses after a child is screened. How can a child in Georgia get help after being screened?GLLF is a 501(c)(3) founded in 1949 to provide surgery services for a four year old boy in need. Since, services have expanded to provide comprehensive eye exams and glasses to those in need all over the state. We currently visit 30 sites with our mobile clinics throughout Georgia. At each clinic, qualifying individuals can receive a fully dilated eye exam and one pair of eyeglasses, which are produced at our Chamblee clinic. The clinics allow the Lighthouse and its partners to diagnose and treat serious eye conditions before the client experiences permanent vision loss. Once a child has been screened and an irregular result is found, a referral to the Lighthouse can be made if they meet financial requirements. Who Can I Contact for Help? District Governors District L District IFred Carlson151 McKlaskey Creek RoadCartersville, GA 30121W: 678-721-6316C: 404-428-7227Email: benchmarkcontrol@Home Club: Bartow CountyAnne Mundy238 Lake CircleDahlonega, GA 30533C: 706-201-0687Email: annem@Home Club: Dahlonega District O District NHannah Flynn4067 Stovall RoadGreenville, GA 30222R: 706-672-4835C: 706-594-5549E: Hannah.flynn@Home Club: GreenvilleLarry Varnadoe386 North Main StreetBaxley, GA 30513R: 912-367-9202C: 912-278-5016Email: larry.varnadoe@Home Club: BaxleyDistrict Directors District L District ICheryl Lee77 Peachtree Place #507Atlanta, GA 30309C: 404-219-9200Email: Cheryl.lee@Home Club: Atlanta June Phillips, PDG 322 Emily Drive, SWLilburn, GA 30047R: 678-924-0562C: 404-784-4156Email: junelieu@Home Club: North Decatur District O District NJ. C. Coefield 105 Fox Den CourtWarner Robins, GA 31093R: 478 922-9023C: 478 955 9132E: coefield@Home Club: CentervillePDG Rick Mizell29 South Nicholson CircleSavannah, GA 31419R: 912-925-9782W: 804-285-6917Email: rickmizell@Home Club: Savannah Port City*Positions will change effective July 1st The Impact: Corey’s Story With Lions KidSight USA, children can proactively be screened before they get the age where eye irregularities become permanent. Sometimes children can have vision problems persisting for years, unnoticed by the child and parents. The Lighthouse has recently launched an effort to make sure this doesn’t happen by reaching out to provide assistance in annual comprehensive eye exams for children. GLLF Children’s Vision Program has coordinated over 860 screenings and comprehensive exams for children across the state. Corey Rankins017462500Thirteen-year-old Corey Rankins was struggling with his schoolwork before he received glasses from the Lighthouse. “He was having trouble with school and had to sit in the front row and still couldn’t see,” said Dana Rankins, Corey’s mom. “That and he was having headaches,” due to the strain to see. Corey’s struggles were more than just not being able to see, “he would get angry, people would tell him, ‘Your vision isn’t that bad,’” Dana said. An eye exam through the Lighthouse showed that Corey really needed glasses because he had a strong prescription. “He put them on and said, ‘Oh thank you God, I can see everything!’’ his mom said happily. “When he got the glasses, which was a new Corey.” Corey can now not only complete his schoolwork better, he can also enjoy playing games at home since he can now see. “The glasses are a blessing,” said Dana.How do I fundraise for KidSight?If you are unable to purchase a vision screener for your club and are looking to fundraise through various means, we have included narrative below that will help supplement any additional information you may need. This information is pertinent to obtaining a vision screener for the purposes of referring children to the Lighthouse only. For more information and explanation of goals/objectives on KidSight, please visit the website found on the cover page of this packet. For more information on the Georgia Lions Lighthouse Foundation, please contact your District Director.Georgia Lions Lighthouse FoundationOrganization DescriptionThe Georgia Lions Lighthouse Foundation (GLLF) is a 501(c)(3) based in Chamblee, Georgia. GLLF was founded in 1949 to provide one eye surgery for a child in need. Since, we have carried a consistent mission of providing individuals with vision and hearing services through education, detection, prevention, and treatment. GLLF is the only statewide provider of vision and hearing services for uninsured and underinsured Georgians who fall under 200% of the Federal Poverty Guidelines (FPG). Our service is possible through collaborative partnerships with our network of partners, volunteer optometrists and ophthalmologists, operating in our 30 traveling clinics throughout Georgia. We enable greater independence and increased quality of life for Georgians in financial need.Children’s Vision Clinic Program Impact and DescriptionProviding eye care for students is imperative. The Journal of Behavior Optometry states that, “80 percent of all learning during a child’s first 12 years is obtained through vision.” Because vision is such an integral component in education, the Lighthouse partners with over 127 public schools throughout the state of Georgia to screen school-aged children. The Lighthouse ended FY2014 serving over 750 children state-wide through the Children’s Vision Clinic Program. Every child served falls below 200% of the Federal Poverty Guidelines, is a resident of Georgia, and is uninsured or underinsured. Over 60% of the children served reside in either DeKalb County or Fulton County. In the Greater Atlanta Metro area a large majority of children patients are African American (61%) or Hispanic (28%). While children of all ages are served, the Lighthouse primarily sees children aged 5 thru 10 (44%), children aged 11 thru 13 (26%) and children aged 14 thru 18 (28%). Over 94% of the children the Lighthouse served in FY2014 received a pair of new prescription eyeglasses manufactured by the Lighthouse at their headquarters in Chamblee. These glasses, provided at no cost to the child or their family, enable children to improve their school engagement and overall quality of life. Children’s Program Objectives:The Lighthouse receives a majority of its children patients through a referral network of partners including but not limited to: the Georgia Charitable Care Network, school based health centers, Federally Qualified Health Centers, and public school systems. In a coordinated effort to serve more children, the Lighthouse is taking part in a new initiative launched by Lions Club International Foundation, Lions KidSight USA. KidSight is a new nationwide initiative launched to screen the vision of children between the ages of six months and six years to check for general care and amblyopia.The Lighthouse is partnering with the Governing Council for the Lions of Georgia to screen children for vision related problems. Lions Clubs will have the active role of engaging their communities to screen children at schools, churches, daycare, and early learning centers. The Lighthouse will track children screened, referred, and follow up with eligible families to ensure the child is receiving adequate vision care.Financial SummaryThe Lighthouse maintains a broad base of funding through individual giving, grants & foundations, public service funding and investment income. Their strategic program growth and budget are approved annually by the Board of Directors. Program projections are based on real expense experiences and then include anticipated capital purchases to further expand programs. Currently, GLLF has received funding for two capital expenses to further grow the children’s program, including the purchase of new mobile van and optical equipment. Evaluating Delivery of ServiceProgram services provided by the Lighthouse continue to be evaluated by pre and post-care surveys developed and updated by Emory’s Rollins School of Public Health. The Lighthouse’s Board of Directors took patient care one step further at the beginning of this current fiscal year and initiated a Quality Assurance (QA) Committee. The QA Committee evaluates effectiveness of service, delivery of care, and patient interactions. Through these measurable efforts and best practices, they are able to qualify their patients’ quality of life (QOL) improvements. The Lighthouse’s Children’s Clinical Program displays the following QOL factors:?84.1% of school-aged children could see the blackboard well/very well after receiving services from the Lighthouse.?88.9% of students could read and complete assignments very well to very well after receiving services from the Lighthouse.?92.7% of students could effectively use a computer after receiving services from the Lighthouse.While patient care is their primary indicator, the Lighthouse ensures that partnering optometrists and clinic sites are provided quality interactions and care as well. Their partnerships have awarded us with dedicated volunteers, Best Practices and Gold Standard clinics, and organizational awards. For more information, please contact your District Director or visit our website:How to Use a Vision Screener Lions Club International partners with both Plusoptix S-12 and the Welch Allyn Spot devices. The Georgia Lions Lighthouse Foundation will rent out equipment to Lions Clubs in need of a device.The following instructions are not a replacement for certified training on operating the Plusoptix S-12 or the Welch Allyn Spot devices. Certified training should be completed before using either screener in the field. Plusoptix S-12Validated measurement technologyImmediate and reliable pass/refer screening resultsBinocular testing of both eyes within 1 secondNon-invasive operation from 39 inches awayInterface to EMR1Print screening reportPrint self-adhesive labelCalibration and maintenance freeEligible for CPT code 99174 (photo screening)77% Capture rateUnique features:Choice of validated sets of referral criteriaPrints screening report in pdf-format to SD memory cardTo operate the Plusoptix S-12 device: First, wrap the strap connected to the device around your neck. This is VITAL because these screening devices are expensive.Turn on the fully charged screening device by pressing the smaller orange power button underneath the screen.To begin screening, Use the touchscreen interface and select the age group that applies to the person you are about to screen. The age groups are all scaled in months, so to calculate the right age group you may need to multiply the child’s age by 12 and then add additional months depending when their birthday was.Once you’ve selected the age group, press the large orange button on the right side of the device.Stand 3 feet away from the child with one foot in front of the other. Line up the camera view shown on the display with the child’s eyes. A square should appear on each pupil with a red/green line connecting them. If the line is fully or partially red you may be standing too close or too far. Move back and forth until the line is solid green. Once the line is green and the eyes are locked into the camera, you will hear a squealing sound letting you know that the camera is capturing followed by a ding to let you know it is complete.Once the capture is complete, the results will be shown on the screen. You can choose to print these results if you have a printer set up or you may copy the results down on your own custom-made sheet. Press the large orange button to go back to the main screen (you do not need to save the file). From there you can start a new screening from the menu by selecting the proper age group and pressing the large orange button again. When you are finished with your all of your screenings, to power off the device, press and hold the power button and then device should shut off.Welch Allyn SpotSupports AAP screening guidelines for early detection of amblyopic risk factorsAutomated screening provides thorough, objective, and easy-to-understand resultsEasy to use, easy to implement with minimal user training requiredAdequately powered for mass screening eventsCaptures readings 97% of the time helping to screen otherwise difficult patientsWireless printing and WiFi-enabled for easy export of dataManual exports available via USB portUses lights and sounds to help engage childrenSpot accurately detects the potential indication of these common vision problems:Myopia (nearsightedness)Hyperopia (farsightedness)Astigmatism (blurred vision)Anisometropia (unequal refractive power)Strabismus (eye misalignment)Anisocoria (unequal pupil size)To operate the Welch Allyn Spot device:First, wrap the strap connected to the device around your wrist. This is VITAL because these screening devices are very expensive. Turn on the fully charged screening device by pressing the black power button underneath the screen area. To begin screening, Use the touchscreen interface and select the age group that applies to the person you are about to screen. In the case of KidSight, the age group should be 6-12 months, 12-36 months, or 3-6 years. Stand 3 feet away from the child with one foot in front of the other. Line up the camera view shown on the display with the child’s eyes. You may be standing too close or too far, and the screener will notify you of this. Once the eyes are locked into the camera, an indicator will appear letting you know that the camera is capturing. Once the capture is complete, the results will be shown on the screen. You can choose to print these results if you have a printer set up or you may copy the results down on your own custom-made sheet. Press home to go back to the main screen (you do not need to save the file). From there you can start a new screening from the menu. When you are finished with your all of your screenings, to power off the device, press and hold the power button and then select confirm on the screen. Children’s pupils are generally easy to capture, however, for the best results with both devices, please shut off as many lights as possible and close all blinds to keep sunlight out to ensure dilated pupils for the best results. -104140106045 2409825142875Please tally all children screened below. Total # PassedTotal # FailedTotal # ScreenedVision Screening Analysis Form adapted with permission from Prevent Blindness Georgia.For questions or additional information please email us at KidSightUSA@ or contact your District Director for more information. 4705350000838294915430500MD-18 ReportDistrict:___________Club:__________________________________Date:________________Site: _________________________________ Site Contact:_____________________________Site Address:_____________________________________________Phone:_______________Screening Follow Up:New Screening Site: Y NHow many total were screened?___________________Between 6 months to 6 years old:____________ Between 7 to 18 years old:____________Between 19 and 30 years old:____________ Between 31 and 50 years old:_____________Between 51 and 70 years old:______________ Above 71 years old:____________________How many referrals for eye examinations do you have?____________________________Who will be following up on your referrals?______________________________________Circle One:Will it be a: Local referral Lighthouse referral Patient Responsibility Combination of Efforts Is your club prepared to provide glasses, if prescribed? Y N Do you need assistance from the Lighthouse? If yes, how? __________________________ ______________________________________________________________________________Lions Recruitment:How many screened were interested in more information about Lions?_______________Who will be following up with those individuals?__________________________________Copy provided to the Lighthouse:_______________________________________________Date:_________________________For questions or additional information please email us at KidSightUSA@ or contact your District Director for more information. 62388751905000002228850-133350267398538735002279658890000ConsConsent FormIs this child currently under the care and treatment of an eye doctor?No□ Yes, eye doctor/clinic City If yes, the screening is not necessary and may not be conducted in order to use our limited resources for children whose vision problems have not been identified.Free vision screening is offered to children by a local Lions Club. Screenings are in conjunction with Lions KidSight USA, Lions Clubs International and The Georgia Lions Lighthouse Foundation, Inc. Vision screening produces images of a child’s eyes to determine the presence of eye disorders including far- and near-sightedness, astigmatism, anisometropia (unequal refractive power), strabismus, (misaligned eyes), and media opacities (e.g., cataracts). No physical contact is made with a child and no eye drops are used during the vision screening. Depending on the equipment used, this screening is approximately 85-90% effective in detecting problems that can cause reduced vision.Participation is voluntary. This screening is designed for pre-school-aged children. Children who are younger than 6-months old will not be screened. No child will be screened without a signed and completed consent form. Each individual child needs his/her own consent form. Please print or type the information below:Child’s Name ()FirstMiddleLastInitialsMale FemaleChild’s Date of Birth// (MM/DD/YYYY)Child’s Age Parent’s Name AddressCityZip Home Phone () Work Phone () Cell Phone () E-mail address Circle One:Race: African-American Caucasian Asian Hispanic American Indian Multiple RaceFamily: Both Parents in house One Parent in house No Parent In House Income: Both Parents employed One Parent Employed Unemployed Disabled Screening Site93091063500Continued on next page…I, the undersigned, hereby give permission for my child, , to participate in the screening event. I understand the following regarding this program:The information obtained from this screening is preliminary only and does not constitute a diagnosis of vision problems.There is no charge to participate in the screening event.I will be contacted with the results of the screening through my child’s care provider who aided in arranging the screening. I may be contacted by telephone regarding follow-up for vision referral by KidSight USA staff at The Georgia Lions Lighthouse Foundation.I am responsible for arranging a full eye examination with a doctor of my choosing if my child has been referred as a result of the vision screening. KidSight USA recommends a dilated eye examination.The results of your child’s eye examination will be shared with KidSight USA as a means to help evaluate the screening program’s effectiveness.KidSight USA will maintain the confidentiality of all records and results.I will not hold the Lions Club and its volunteers, Lions Clubs organizations, The Georgia Lions Lighthouse Foundation, or affiliates, accountable for any errors of commission, omission or other misdiagnosis. There are no foreseeable risks to participating in the KidSight USA vision screening.504825077470Signature of Parent or GuardianDateName of Club: __________________________ District: ____________________Primary KidSight Contact for Club: ______________________KidSight USA is a nationwide program launched by Lions Club International (LCI) to safeguard the vision of children aged 6 months through 6 years.Is your Lions Club aware of the LCI KidSight USA Program? ? Yes? NoIf you answered “yes” in question #1, please indicate who has talked to you about KidSight USA? (Check All)? District Governor ? District Director? Georgia Lions Lighthouse Foundation Staff Member? Club President? LCI Staff Member? Other: _______________Has your club participated in vision screenings before?? Yes? NoIf you answered “yes” in question #3, how many hours per month do you spend conducting screenings? (Select One)? Less than 8 hours ? 8 - 16 hours? 17 hours or moreIf you answered “no” in question #3, why not? (Check All)? Not interested nor part of our club’s focus ? No screening equipment available to use? Having a hard time finding locations to screen? Other: _______________Is your club interested in participating in the LCI KidSight USA Program?? Yes? NoIf your Lions Club decides to participate in KidSight USA will you share your data monthly with the Lighthouse? ? Yes ? No Is your club familiar with the vision screening equipment needed to carry out the KidSight USA program?? Yes, we have used Welch Allyn/PlusOptix screeners in the past? NoIf you answered “yes” in question #8, how did you obtain the vision screener? ? We have rented the screeners ? We have bought/are in the process of buying screenersHas a club member attended a training on how to use the Welch Allyn and/or PlusOptix vision screener? Yes? NoIf you answered “yes” in question #10, which machine were they trained to use? (Check all)? Welch Allyn Spot Machine ? PlusOptixIf you answered “no” in question #10, is your club interested in being trained on how to use a vision screener?? Yes ? No Does your Lions Club have a referral network after a child has been screened and deemed that an exam is needed? ? Yes, we refer screened children to the Lighthouse ? Yes, we refer screened children to a local doctor? Yes, the school refers screened children? No, but our club needs help establishing a referral network in our community? Other: _______________Does your club provide glasses for children? ? Yes, we provide glasses through the Lighthouse? Yes, we provide glasses independently? NoHow can the Lighthouse better assist you with KidSight USA (coordination of services, reporting of data, preparation of eyeglasses, training, equipment, etc.)?Is there additional information your club would like to have about the KidSight USA program? ................
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