R384.  Health, Disease Control and Prevention, Health Promotion.
R384-201.  School-Based Vision Screening for Students in Public Schools.
R384-201-1.  Authority.
	(1)  This rule is authorized by section 53G 9-404 and 26-1-30 (33).
	(2)  The Department of Health is authorized under the rule to set standards and procedures for vision screening required by this chapter, which shall include a process for notifying the parent or guardian of a student who fails a vision screening or is identified as needing follow-up care.

R384-201-2.  Definitions.
	(1)  "Eye care professional" means an ophthalmologist or optometrist.
	(2)  IEP means an Individualized Education Plan.
	(3)  "Instrument based screening" means an automated screening technique that facilitates vision screening in students who are difficult to screen such as children with developmental delays.
	(4)  LEA means local education agency.
	(5)  "Screening certificate" means written documentation of vision screening or comprehensive eye examination by a health care professional as defined in 53G-9-404 (1)(a)done within one year of entering a public school.
	(6)  "Significant visual impairment" means a visual impairment severe enough to interfere with learning. The term is the designation required for a child to be eligible for services from a teacher of students with visual impairments in an LEA or USDB.
	(7)  "Screener" means those trained to support vision screening programs for students.
	(8)  USDB means Utah Schools for the Deaf and Blind.
	(9)  UDOH means Utah Department of Health.
	(10)  "Vision Screening" means a way to identify students with visual impairment.

R384-201-3.  Purpose.
	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 students so that follow-up for potential concerns may be done by the student's parent or guardian.  Vision screening is not a substitute for a complete eye exam and vision evaluation by an eye care professional.

R384-201-4.  Free Screening.
	The following students in an LEA shall receive free vision screenings to include tier 1 screening.
	(1)  Vision screening shall be conducted for all students in grades pre-kindergarten, kindergarten, 1, 3, 5, 7 or 8, and 9 or 10 and any student referred by school personnel, parent or guardian or self to rule out vision as an obstacle to learning;
	(2)  Tenth grade students may be screened as part of their driver education class; and
	(3)  Students who are currently receiving services from USDB or LEA vision specialist who have a diagnosed significant visual impairment will be exempt from screening.
	(4)  Students may be referred for mandatory or optional tier 2 vision screening under the following circumstances in (a) and (b).
	(a)  Mandatory tier 2 screening may be done for students requiring education intervention such as special education referral or failing benchmark reading assessment as defined by R277-404.
	(b)  Optional tier 2 vision screening may be done based on parent or teacher concern.
	(c)  Students failing a tier 1 screening who have been referred to an eye care professional are not required to complete a tier 2 screening.
	(d)  Instead of performing a tier 2 vision screening, the LEA may automatically refer the student being referred to a tier 2 vision screening to an eye care professional.
	(e)  If the LEA does not have a school nurse or other approved tier 2 screener, the student being referred for a tier 2 vision screening should be automatically referred to an eye care professional.

R384-201-5.  Required Screening for Students with an Individualized Education Plan.
	Required screening for students identified with an IEP in an LEA are as follows:
	(1)  Vision issues have to be ruled out as an obstacle to learning before Specific Learning Disability can be used as eligibility criteria and
	(2)  Every three years, a student must be reevaluated for eligibility for special education in all areas of suspected disability, including vision.

R384-201-6.  Proof of Screening.
	Certificate or health form documenting a vision screening or examination given within one year of entering a public school are acceptable for school entry. All students less than age 9 entering a public school in Utah for the first time without proof of screening mentioned above, shall be screened during that school year.

R384-201-7.  Training of Screeners.
	(1)  The LEA shall provide training annually to all vision screeners prior to the start of vision screenings.
	(a)  The school nurse shall provide training shall be provided to the vision screeners; or
	(b)  Vision screeners shall view the online module developed by UDOH referred to in 53G-9-404 (4)(b).
	(2)  The LEA will provide trainings in compliance with UDOH materials.
	(3)  The LEA will share vision screening training materials with qualified outside entities that provide free vision screening services in Utah schools.
	(4)  UDOH will create online training modules on:
	(a)  Tier 1 vision screening; and
	(b)  Training for tier 1 vision screeners; and
	(c)  Tier 2 vision screening for school nurses or other approved tier 2 screeners.

R384-201-8.  Screening.
	(1)  Screenings are to be performed following criteria developed by UDOH.
	(2)  Screeners should do vision screenings early in the school session to provide time in that school year for adequate referral and follow-up to be done.
	(3)  A Parent or guardian of a student has the right not to have their student participate in vision screening.  All parents or guardians must be notified of scheduled vision screenings by the public school to provide an opportunity to opt out of screening for their student. Parent or guardian choosing to opt out of vision screening for their student must do so annually and in writing.
	(4)  A public school staff member should be present at all times during vision screenings including those done by qualified outside entities.
	(5)  Screenings are to be done using material and procedures approved by UDOH.  Standards and procedures are based on recommendations of American Academy of Pediatrics, the American Academy of Ophthalmology, the American Optometric Association, the National Center for Children's Vision and Eye Health, and National School Nurse Association.
	(6)  School vision screening is comprised of tier 1 and tier 2 screening.
	(a)  Tier 1 vision screening is a lower-level vision screening such as basic distance vision screening.
	(b)  Tier 2 vision screening is a higher-level evaluation that should include screening of distance and near vision.  It may also include eye focusing or tracking problems, color screening, and screening for convergence insufficiency.
	(i)  The approved tier 2 screener may automatically refer the student to an eye care professional in lieu of performing the tier 2 screening.
	(ii)  If the LEA does not have an approved tier 2 screener the LEA should automatically refer the student to an eye care professional.
	(7)  Approved vision screeners include the following:
	(a)  Approved tier 1 vision screeners can be school nurses, qualified outside entities, trained volunteers, or health care professionals as defined in 53G-9-404 (1)(a) who have completed UDOH training for tier 1 vision screening.
	(b)  Approved tier 2 vision screeners can only be school nurses or health care professionals as defined in 53G-9-404 (1)(a) who have completed UDOH training for tier 2 vision screening.
	(c)  Persons assisting with vision screening:
	(i)  May not profit financially from school vision screening; and
	(ii)  May not market, advertise, or promote a business in connection with assisting with vision screening.
	(8)  Any qualified outside entity that provides free vision screening services in the LEA will provide results of vision screening to the public school.
	(9)  Students who are not candidates for regular vision screening may be screened using an approved instrument-based screening device.  Only devices approved by UDOH should be used for screening, and then only when screening with a chart is not an option.  Devices are not a substitute for clinical judgement and a visual acuity test.
	(10)  The LEA shall document all vision screening results including referrals and follow-up results in the student's permanent school record.

R384-201-9.  Requirements for Referral.
	(1)  A school nurse may rescreen students who fail initial age appropriate school vision screening to confirm results before notification to student's parent or guardian of any impairment disclosed by the vision screening recommending further evaluation by an eye care professional.
	(2)  The LEA shall notify, in writing within 30 days from vision screening, a student's parent or guardian of any impairment disclosed by the vision screening recommending further evaluation by an eye care professional.

R384-201-10.  Symptoms Questionnaire.
	(1) The UDOH will provide schools a vision symptoms questionnaire that includes questions for classroom teachers to potentially identify eye focusing or tracking problems as well as convergence insufficiency. The UDOH will update the questionnaire as needed.
	(2)  For students who fail to achieve benchmark status on the benchmark reading assessment in grades 1-3:
	(a)  The LEA shall notify the student's teacher within 30 calendar days of student performance on the benchmark reading assessment.
	(b)  Teachers must complete the vision symptoms questionnaire within 45 calendar days of the administration of the assessment and submit to the school nurse.
	(c)  Teachers need only complete the vision symptoms questionnaire once per school year.
	(d)  School nurses or other approved tier 2 vision screeners shall use the vision symptoms questionnaire to perform a secondary assessment and/or refer to an eye care professional.
	(3)  For students who are being referred to special education for a suspected disability affected by vision difficulties:
	(a)  Teachers must complete the vision symptoms questionnaire and submit to the school nurse.
	(b)  School nurses or other approved tier 2 vision screeners shall use the vision symptoms questionnaire to perform a secondary assessment and/or refer to an eye care professional.
	(4)  For students who are being referred by parent or guardian for vision concern:
	(a)  Parent or guardian should complete the vision symptoms questionnaire and submit to the school nurse.
	(b)  School nurses or other approved tier 2 vision screeners shall use the vision symptoms questionnaire to perform a secondary assessment and/or refer to an eye care professional.

R384-201-11.  Aggregate Reporting Requirements.
	(1)  All LEAs shall report aggregate numbers annually to UDOH to include:
	(a)  Total number of students receiving tier 1 vision screening; and
	(b)  Total number of students referred to an eye care professional following a tier 1 vision screening; and
	(c)  Total number of students referred to school nurse for tier 2 screening; and
	(d)  Total number of students referred to an eye care professional following a tier 2 vision screening; and
	(e)  Other information as requested by UDOH.
	(2)  This report may be submitted on the annual vision screening report, or as part of the annual school health workload census, and shall be due on or before June 30 of each year.
	(3)  No personally identifiable information will be collected.

KEY:  eye exams, school vision, vision evaluations
Date of Enactment or Last Substantive Amendment:  August 1, 2019
Notice of Continuation:  June 7, 2018
Authorizing, and Implemented or Interpreted Law:  53G-9-404