....................'.:.....
from the NotesField~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~...........
:f.
Editor's Note: Submissions to Notes from the Field (50S-1000 words, preferably without references, tables, or figures) should be sent to Hugh H. Tilson, MD,
Epidemiology, Surveillance&Pharnacoeconomics (ESP) Division, Burroughs Weilcome Co., 3030 Cormwallis Road, Research TnangleParkc NC27709. This column presents infonnation on newsworthy public health programs and project expenences at the community level. Further information should be soughtfrom the author(s) listed at the end of each article.
Hooray for Health! A Health Education Program for Day-Care Home Providers In June 1989, the Washtenaw County, Michigan (Population: 286 600), Public Health Division initiated Hooray for Health!, a health education program for group and family day-care home (DCH) providers, children, and parents. Its purpose is to promote and support safe and healthy child-care settings. This county, like many others in the state, experienced an increase in the number of DCHs beginning in the early 1970s. Concerned that the majority ofDCH providers have limited backgrounds in child health, safety, development, and education and prompted by a number of cases of giardia in local day-care settings, the health education staff developed Hooray for Health! to enhance the provider's caregiving skills. The overall aim of Hooray for Health! is to offer timely, accurate, and usable consultation and support to DCH providers to decrease the risk of health problems. The program goals are to interrupt the isolation of providers and enable
December 1991, Vol. 81, No. 12
them to become more confident and competent in creating a safe and healthy environment for children; provide health information and resources to working parents whose children are in day-care; and encourage providers to teach children good health habits. Washtenaw County is located in southeast Michigin, approximately 40 miles west of Detroit. The Washtenaw County Public Health Division, with a staff of 130, is committed to promoting the health of all residents in the county. The Department of Social Services/ Division of Child Care Licensing is the state agency responsible for licensing child-care centers and group and family DCHs. In Michigan, persons providing paid care in their home to a child not related to them must be licensed. Currently, there are 629 DCH providers in Washtenaw County: 106 group DCHs are licensed to care for up to 12 children each, and 523 family DCHs are licensed to care for up to six children per home. The purpose of the Division of Child Care Licensing is to decrease potential risks to children through prevention. The division provides a 2-hour orientation to child-care providers during which relevant concerns are discussed, including Michigan's Child Protection Law; supervision and discipline guidelines; spotting signs ofchild abuse; food, medication, and required health information; and Michigan's licensing rules for DCHs. This brief orientation serves as a foundation for newly licensed providers to develop quality DCHs. In 1989, Public Health Division staff, concerned about the brevity of the orientation and the potential for health problems in DCHs, approached the Division of Child Care Licensing with a proposal to supplement its efforts with a home-based program. As a result of this contact,
Washtenaw County and the Division of Child Care Licensing have established a unique and successful working relationship. Through Hooray for Health! they reach approximately 75 DCH providers each year. The initial focus of Hooray for Health! was on at-risk licensed DCH providers. During the pilot project (June to August 1989), approximately 9% of the 610 DCH providers in the county were identified by the Division of Child Care Licensing as "at-risk" for one of two reasons: either the providers themselves needed consultation and support, or they were caring for children and families in need of support. Nineteen of the 54 DCHs identified by the division participated in the pilot program. In September 1989, the focus of Hooray for Health! changed from intervention to prevention when the Division of Child Care Licensing began to refer all newly licensed DCH providers to the Public Health Division. Each month, an average of 12 DCHs are licensed, and over half of these voluntarily participate in the program. During the orientation session, the Division of Child Care Licensing informs providers about Hooray for Health!, and later gives the Public Health Division a list of names and addresses of all new providers. The Public Health Division then follows up with letters, interest surveys, and telephone calls. Staff call all providers and encourage them to participate in the program stressing convenience (staff make home visits), cost (the program is free), and benefits (the Public Health Division shares education and materials with providers and working parents). Hooray for Health! staff meet individually with providers at their day-care settings and during informal discussions determine which topics are most relevant American Journal of Public Health 1667
Notes fn the Fkid
to a particular DCH. During the series of three to six biweekly home visits, staff do the following: * Discuss topics covered in the Horray for Health! manual * Answer provider's questions and make referrals * Provide general information on Public Health Division clinics and programs of interest to working parents * Lend books from the Public Health Division libraiy * Work with child on topics such as
smoking prevention, nutrition, handwashing, and seatbelt use Hooray for Health! is staffed by five health educators, each of whom specializes in another health promotion area (school health, minority health, smoking cessation). Student nurses and health education interns also carty their own small caseloads. Staff devote approximately 3 hours perweek to the program. Each staff member is assigned a caseload of DCH providers. When needed, two staff members visit the home: one consults with the provider while the other educates the children. This model allows staff to help providers learn how to establish and maintain safe and healthy day-care settings with minimal interruptions. Staff present topics in a manual developed by Hooray for Health! specifically for DCH providers. The manual includes sections on * Maintaining health and avoiding illnesses in the day-care setting * Creating a safe environment for children * Leaming about child development * Working with children who are "challenging" (discussed are causes, solutions and interventions for health- and behavior-related problems) * Communicating with parents * Identifying and reducing the provider's stress * Enhancing the provider's business (e.g., how to write contracts and find materials) Each section of the manual is easy to read and offers practical suggestions, education materials, and community resources for providers and working parents. The manual also serves as a "trigger" for health activities that staff and providers can do with children. Bars of soap are used to teach children the importance of handwashing; no-smoking puppets and coloring books from the American Cancer Society, safety coloring books 1668 American Journal of Public Health
from the Office of Highway Safety and Planning, and the Nutrition Fishing Game from the Public Health Division give preschoolers hands-on opportunities to learn about being healthy. Hooray for Health! is a low-budget program. Personnel costs, which account for 90%o of the $12 000 budget, are kept low when students of nursing and health education help staff the program. Printing and binding, travel and postage costs are the other major expenses. Assuming an annual caseload of 75 providers, the cost per day care setting is $160.00. Hooray for Health! has grown considerably since its inception. To date staff have visited 148 DCH providers and 915 children and have indirectly reached 617 working families. Additionally, Hooray for Health! has become involved with the Michigan Child Care Futures Project, a state-funded program whose aim is to recruit, train, and encourage licensure of unlicensed child care providers. Hooray for Health! staff, in a group setting, present information on child health and safety. Following licensure, program staff work individually with providers on these and other health topics. Four-month follow-up telephone calls or visits to all pilot project DCHs determined provider satisfaction, materials and services used, and changes in children's awareness of healthy habits. Providersvalued most the personal contact (especially the one-to-one review of materials) and the health information for children and their working parents. Topics most often requested included communicable diawes, challenging children, personal health, communicating with parents, and enhancing the day care as a business. Most providers shared information with parents, some of whom subsequently used the services of the Public Health Division. A more recent evaluation of 22 DCH providers further supported these findings. Some comments from providers were as follows: "The program opened up a whole new line of resources I didn't know existed"; "Hooray! helped me become a better provider, especially when setting groundniles for parents with sick children"; and "Handwashing (a children's activity) was a hit!" In future evaluations, we will ask providers about the frequency and severity of illnesses that occurred among children after visits from Hooray for Health! to daycare centers. Partly on the basis of the evaluation results, staff developed several new components: an environmental health section
for the manual; a workshop where providers learn in a group how to make inexpensive games and exercise a part of the day-care program; additional materials for parents and activity sheets for children to accompany specific sections in the manual; and a biannual newsletter for the providers of the program. The Public Health Division has a vested interest in supporting quality daycare settings. First, the demand for child care is great. Nationally in 1987, approximately 57% of worldng mothers had children under the age of6 who required "other than mother" child-care; in contrast, in 1970 only 30% had this need. Second, communicable diseases and accidents are frequently reported as top concerns of day-care providers and parents. Third, millions of children have no health insurance; their health care is crisis- rather than prevention-focused. Fortunately, providers are willing to do their part to address children's needs. Many DCH providers are receptive to health education and willing to assume some responsibility for enhancing the health and safety of children in their care. Hooray for Health!, an innovative yet traditional public health program, offers the assistance providers need to decrease the risk of potential health problems in the day-care setting. For further information and program materials (available for $5.00) please contact the author listed below. l Mwy Ann Ri; AMPH Requests for reprints should be sent to Mary Ann Rizk, Public Health Division, Washtenaw County Human Services Department, 4101 Washtenaw Road, Ann Arbor, NU 48107-8645.
Acknowledgments The author would like to thank Beverly Chethik, Chief of the Community Health Bureau/Washtenaw County, Michigan, Public Health Division, for her review and comments on this manuscript, and the Hooray for Health! staff for their commitment and support.
Lazy Eyes and Public Vision: Health Department Focus on Preschool Vision Testing The Governing Council of APHA in 1989 adopted policy statement no. 8905, recognizing the need for and the importance of children's preschool vision and hearing screening programs. This reaffirmation stimulated this historical overview of the experiences in one county.
December 1991, Vol. 81, No. 12
Notes from the FSid
Early in the 60s the City-County Health Department of Eau Claire, Wis (population 84 269) tried to find preschool children with vision problems, but soon realized that only 10% of the preschool children could be reached by centralized clinics and that many of those children were close to school age. Amblyopia ("lazy eye") needs to be identified at 3 to 4 years of age. A strategy was needed that would permit parents to screen their own preschool children at home, e.g., with a test or kit that was reasonably simple, accurate, and dependable. Two graduate students from Stanford University, majoring in health education, spent a 2-month field experience at the Health Department developing and field testing such kit ideas. The results prompted the department to apply for a demonstration project, which was funded by the US Public Health Service in 1966, entitled Vision Testing by Parents of 3½ Year Old Children. The results showed that suspected cases of amblyopia could be identified by parents with the do-it-yourself kit, which was copyrighted in 1968. The prevalence of amblyopia was found to be 1.65% for the group of 1000 children; of these, slightly more than half (0.98%) were previously not known to have amblyopia. Some 3½2-year-old children were not mature enough to be screened. Thirty percent of the parents (297) returned their test result on a stamped, self-addressed postcard within a month of receipt. Follow-up phone calls (192) brought the response rate to 50%, which was considered good. The Board of Health decided in 1970 to undertake a communitywide preschool vision screening program based on the kit and its tested methodology. The target age for screening was changed to 4 years, and birth certificates were used to mail kits to all 4-year-olds. Parents having difficulty testing their child could call the department or use the self-addressed response card in each kit, also used to collect results. The ophthalmologists in Eau Claire helped to develop the demonstration project and continued to provide findings from their professional practice on a form developed for the project and to make referrals to the public health nurses. To make kits available beyond the service area of the City-Council Health Department and respond to inquiries, a private nonprofit group called Lazy Eye,
December 1991, Vol. 81, No. 12
Ltd., was established by volunteers who had worked with the department. Their efforts included providing parents with information on amblyopia and the importance of early vision problem identification and correction. A picture book entitled Charlie's Lazy Eye was developed to appeal to children and parents. The picture book continues in use, paid for by the Eau Claire Lions Club, and it is mailed with each kit. The data collected from the countywide program begun in 1970 are divided into two periods. The first period covers the 15-year findings through 1985. The response by parents during this time averaged a return of 70%, up from 50% during the original project, and served to screen 7024 children. The experience confirmed the beliefthat parents could and would use the kit to look for vision problems and facilitate their early identification and correction. The second period, 1986 to 1989, for which fewer data are available, produced a return rate of 62%, which represented the screening of 2498 children. Results were reviewed by a public health nurse to encourage appropriate action and assist parents as needed. During the early years, ophthalmologists were good about reporting their findings to the department and were the main source of primary eye care. In recent years, Eau Claire has experienced an increase of optometric providers of primary eye care and although the ophthalmologists continue to provide such care, many now spend more time on secondary and tertiary care. These changes among the eye care providers in the community were not recognized by the department, and program awareness among the professionals suffered as did reporting. Program efforts were directed at finding amblyopia, but it was found that many "other vision problems" could be detectedbyparents. Of the 118 "othervision problems" detected during the first 15 years, parents helped find 68. Parents also helped find an average of 1.3 new cases of amblyopia for each of the 15 years, which were confirmed by professional examination. The reported new case rate from the eye doctors averaged one case of amblyopia a year during the same period. Together parents and professionals found 35 cases. The expected number of cases of amblyopia among the 7024 children
screened was 68; thus the results represent only 50% of the expected cases. On the other hand, without the parents' efforts the professional community would have found only 22% ofthe expected number of cases. However, results are dependent on consistent reporting. These results must be interpreted with caution because of possible differences in case definition and underreporting. The findings reaffirm the belief that a home screening kit has merit in involving parents as partners in efforts to find vision problems early when they are most amenable to correction. A 1988 national survey of the states by Lazy Eye Ltd (unpublished) produced 21 responses and indicated that only three states had information on the numbers of cases of amblyopia they had found. Estimates of incidence among preschool children ranged from 0.1% to 6.75%. Three states were also able to provide an estimate of frequency for the total vision problems found, which ranged from 1.4% to 3.1% for the children screened. Only one state had screened almost 50% of prekindergarten-age children. Most states rely on school-centered programs to reach children at risk of amblyopia. The kit and mailing cost are still less than $1.00 per child. However, the program does require the health department to collect and evaluate the findings and provide information to the public and the professionals in Eau Claire. The costs were minimal and did not require separate budgeting. Enlisting the help of volunteers is also essential, to keep costs down and community support up. The materials descrnled in this paper can be obtained at cost from Lazy Eye Ltd. of Eau Claire County, 1521 Folsom Street, Eau Claire, WI 54703. The kit costs ¢10, the Charlie book ¢25, and a "How-to" Brochure ¢15. A video cassette is also available for rental for a fee of $5.00. The time-tested materials and the methodology used offer a good starting point for building a sound program. Twenty years of experience in Eau Claire and the results of the recent national survey underline the urgency and import of the APHA resolution. E John A. Bachanch, M:PH Requests forrepnnts should be sent to JohnA. Bacharach, MPH, 104 East Trunan Avenue, Eau Claire, WI 54701.
American Journal of Public Health 1669
from the NotesField~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~...........
:f.
Editor's Note: Submissions to Notes from the Field (50S-1000 words, preferably without references, tables, or figures) should be sent to Hugh H. Tilson, MD,
Epidemiology, Surveillance&Pharnacoeconomics (ESP) Division, Burroughs Weilcome Co., 3030 Cormwallis Road, Research TnangleParkc NC27709. This column presents infonnation on newsworthy public health programs and project expenences at the community level. Further information should be soughtfrom the author(s) listed at the end of each article.
Hooray for Health! A Health Education Program for Day-Care Home Providers In June 1989, the Washtenaw County, Michigan (Population: 286 600), Public Health Division initiated Hooray for Health!, a health education program for group and family day-care home (DCH) providers, children, and parents. Its purpose is to promote and support safe and healthy child-care settings. This county, like many others in the state, experienced an increase in the number of DCHs beginning in the early 1970s. Concerned that the majority ofDCH providers have limited backgrounds in child health, safety, development, and education and prompted by a number of cases of giardia in local day-care settings, the health education staff developed Hooray for Health! to enhance the provider's caregiving skills. The overall aim of Hooray for Health! is to offer timely, accurate, and usable consultation and support to DCH providers to decrease the risk of health problems. The program goals are to interrupt the isolation of providers and enable
December 1991, Vol. 81, No. 12
them to become more confident and competent in creating a safe and healthy environment for children; provide health information and resources to working parents whose children are in day-care; and encourage providers to teach children good health habits. Washtenaw County is located in southeast Michigin, approximately 40 miles west of Detroit. The Washtenaw County Public Health Division, with a staff of 130, is committed to promoting the health of all residents in the county. The Department of Social Services/ Division of Child Care Licensing is the state agency responsible for licensing child-care centers and group and family DCHs. In Michigan, persons providing paid care in their home to a child not related to them must be licensed. Currently, there are 629 DCH providers in Washtenaw County: 106 group DCHs are licensed to care for up to 12 children each, and 523 family DCHs are licensed to care for up to six children per home. The purpose of the Division of Child Care Licensing is to decrease potential risks to children through prevention. The division provides a 2-hour orientation to child-care providers during which relevant concerns are discussed, including Michigan's Child Protection Law; supervision and discipline guidelines; spotting signs ofchild abuse; food, medication, and required health information; and Michigan's licensing rules for DCHs. This brief orientation serves as a foundation for newly licensed providers to develop quality DCHs. In 1989, Public Health Division staff, concerned about the brevity of the orientation and the potential for health problems in DCHs, approached the Division of Child Care Licensing with a proposal to supplement its efforts with a home-based program. As a result of this contact,
Washtenaw County and the Division of Child Care Licensing have established a unique and successful working relationship. Through Hooray for Health! they reach approximately 75 DCH providers each year. The initial focus of Hooray for Health! was on at-risk licensed DCH providers. During the pilot project (June to August 1989), approximately 9% of the 610 DCH providers in the county were identified by the Division of Child Care Licensing as "at-risk" for one of two reasons: either the providers themselves needed consultation and support, or they were caring for children and families in need of support. Nineteen of the 54 DCHs identified by the division participated in the pilot program. In September 1989, the focus of Hooray for Health! changed from intervention to prevention when the Division of Child Care Licensing began to refer all newly licensed DCH providers to the Public Health Division. Each month, an average of 12 DCHs are licensed, and over half of these voluntarily participate in the program. During the orientation session, the Division of Child Care Licensing informs providers about Hooray for Health!, and later gives the Public Health Division a list of names and addresses of all new providers. The Public Health Division then follows up with letters, interest surveys, and telephone calls. Staff call all providers and encourage them to participate in the program stressing convenience (staff make home visits), cost (the program is free), and benefits (the Public Health Division shares education and materials with providers and working parents). Hooray for Health! staff meet individually with providers at their day-care settings and during informal discussions determine which topics are most relevant American Journal of Public Health 1667
Notes fn the Fkid
to a particular DCH. During the series of three to six biweekly home visits, staff do the following: * Discuss topics covered in the Horray for Health! manual * Answer provider's questions and make referrals * Provide general information on Public Health Division clinics and programs of interest to working parents * Lend books from the Public Health Division libraiy * Work with child on topics such as
smoking prevention, nutrition, handwashing, and seatbelt use Hooray for Health! is staffed by five health educators, each of whom specializes in another health promotion area (school health, minority health, smoking cessation). Student nurses and health education interns also carty their own small caseloads. Staff devote approximately 3 hours perweek to the program. Each staff member is assigned a caseload of DCH providers. When needed, two staff members visit the home: one consults with the provider while the other educates the children. This model allows staff to help providers learn how to establish and maintain safe and healthy day-care settings with minimal interruptions. Staff present topics in a manual developed by Hooray for Health! specifically for DCH providers. The manual includes sections on * Maintaining health and avoiding illnesses in the day-care setting * Creating a safe environment for children * Leaming about child development * Working with children who are "challenging" (discussed are causes, solutions and interventions for health- and behavior-related problems) * Communicating with parents * Identifying and reducing the provider's stress * Enhancing the provider's business (e.g., how to write contracts and find materials) Each section of the manual is easy to read and offers practical suggestions, education materials, and community resources for providers and working parents. The manual also serves as a "trigger" for health activities that staff and providers can do with children. Bars of soap are used to teach children the importance of handwashing; no-smoking puppets and coloring books from the American Cancer Society, safety coloring books 1668 American Journal of Public Health
from the Office of Highway Safety and Planning, and the Nutrition Fishing Game from the Public Health Division give preschoolers hands-on opportunities to learn about being healthy. Hooray for Health! is a low-budget program. Personnel costs, which account for 90%o of the $12 000 budget, are kept low when students of nursing and health education help staff the program. Printing and binding, travel and postage costs are the other major expenses. Assuming an annual caseload of 75 providers, the cost per day care setting is $160.00. Hooray for Health! has grown considerably since its inception. To date staff have visited 148 DCH providers and 915 children and have indirectly reached 617 working families. Additionally, Hooray for Health! has become involved with the Michigan Child Care Futures Project, a state-funded program whose aim is to recruit, train, and encourage licensure of unlicensed child care providers. Hooray for Health! staff, in a group setting, present information on child health and safety. Following licensure, program staff work individually with providers on these and other health topics. Four-month follow-up telephone calls or visits to all pilot project DCHs determined provider satisfaction, materials and services used, and changes in children's awareness of healthy habits. Providersvalued most the personal contact (especially the one-to-one review of materials) and the health information for children and their working parents. Topics most often requested included communicable diawes, challenging children, personal health, communicating with parents, and enhancing the day care as a business. Most providers shared information with parents, some of whom subsequently used the services of the Public Health Division. A more recent evaluation of 22 DCH providers further supported these findings. Some comments from providers were as follows: "The program opened up a whole new line of resources I didn't know existed"; "Hooray! helped me become a better provider, especially when setting groundniles for parents with sick children"; and "Handwashing (a children's activity) was a hit!" In future evaluations, we will ask providers about the frequency and severity of illnesses that occurred among children after visits from Hooray for Health! to daycare centers. Partly on the basis of the evaluation results, staff developed several new components: an environmental health section
for the manual; a workshop where providers learn in a group how to make inexpensive games and exercise a part of the day-care program; additional materials for parents and activity sheets for children to accompany specific sections in the manual; and a biannual newsletter for the providers of the program. The Public Health Division has a vested interest in supporting quality daycare settings. First, the demand for child care is great. Nationally in 1987, approximately 57% of worldng mothers had children under the age of6 who required "other than mother" child-care; in contrast, in 1970 only 30% had this need. Second, communicable diseases and accidents are frequently reported as top concerns of day-care providers and parents. Third, millions of children have no health insurance; their health care is crisis- rather than prevention-focused. Fortunately, providers are willing to do their part to address children's needs. Many DCH providers are receptive to health education and willing to assume some responsibility for enhancing the health and safety of children in their care. Hooray for Health!, an innovative yet traditional public health program, offers the assistance providers need to decrease the risk of potential health problems in the day-care setting. For further information and program materials (available for $5.00) please contact the author listed below. l Mwy Ann Ri; AMPH Requests for reprints should be sent to Mary Ann Rizk, Public Health Division, Washtenaw County Human Services Department, 4101 Washtenaw Road, Ann Arbor, NU 48107-8645.
Acknowledgments The author would like to thank Beverly Chethik, Chief of the Community Health Bureau/Washtenaw County, Michigan, Public Health Division, for her review and comments on this manuscript, and the Hooray for Health! staff for their commitment and support.
Lazy Eyes and Public Vision: Health Department Focus on Preschool Vision Testing The Governing Council of APHA in 1989 adopted policy statement no. 8905, recognizing the need for and the importance of children's preschool vision and hearing screening programs. This reaffirmation stimulated this historical overview of the experiences in one county.
December 1991, Vol. 81, No. 12
Notes from the FSid
Early in the 60s the City-County Health Department of Eau Claire, Wis (population 84 269) tried to find preschool children with vision problems, but soon realized that only 10% of the preschool children could be reached by centralized clinics and that many of those children were close to school age. Amblyopia ("lazy eye") needs to be identified at 3 to 4 years of age. A strategy was needed that would permit parents to screen their own preschool children at home, e.g., with a test or kit that was reasonably simple, accurate, and dependable. Two graduate students from Stanford University, majoring in health education, spent a 2-month field experience at the Health Department developing and field testing such kit ideas. The results prompted the department to apply for a demonstration project, which was funded by the US Public Health Service in 1966, entitled Vision Testing by Parents of 3½ Year Old Children. The results showed that suspected cases of amblyopia could be identified by parents with the do-it-yourself kit, which was copyrighted in 1968. The prevalence of amblyopia was found to be 1.65% for the group of 1000 children; of these, slightly more than half (0.98%) were previously not known to have amblyopia. Some 3½2-year-old children were not mature enough to be screened. Thirty percent of the parents (297) returned their test result on a stamped, self-addressed postcard within a month of receipt. Follow-up phone calls (192) brought the response rate to 50%, which was considered good. The Board of Health decided in 1970 to undertake a communitywide preschool vision screening program based on the kit and its tested methodology. The target age for screening was changed to 4 years, and birth certificates were used to mail kits to all 4-year-olds. Parents having difficulty testing their child could call the department or use the self-addressed response card in each kit, also used to collect results. The ophthalmologists in Eau Claire helped to develop the demonstration project and continued to provide findings from their professional practice on a form developed for the project and to make referrals to the public health nurses. To make kits available beyond the service area of the City-Council Health Department and respond to inquiries, a private nonprofit group called Lazy Eye,
December 1991, Vol. 81, No. 12
Ltd., was established by volunteers who had worked with the department. Their efforts included providing parents with information on amblyopia and the importance of early vision problem identification and correction. A picture book entitled Charlie's Lazy Eye was developed to appeal to children and parents. The picture book continues in use, paid for by the Eau Claire Lions Club, and it is mailed with each kit. The data collected from the countywide program begun in 1970 are divided into two periods. The first period covers the 15-year findings through 1985. The response by parents during this time averaged a return of 70%, up from 50% during the original project, and served to screen 7024 children. The experience confirmed the beliefthat parents could and would use the kit to look for vision problems and facilitate their early identification and correction. The second period, 1986 to 1989, for which fewer data are available, produced a return rate of 62%, which represented the screening of 2498 children. Results were reviewed by a public health nurse to encourage appropriate action and assist parents as needed. During the early years, ophthalmologists were good about reporting their findings to the department and were the main source of primary eye care. In recent years, Eau Claire has experienced an increase of optometric providers of primary eye care and although the ophthalmologists continue to provide such care, many now spend more time on secondary and tertiary care. These changes among the eye care providers in the community were not recognized by the department, and program awareness among the professionals suffered as did reporting. Program efforts were directed at finding amblyopia, but it was found that many "other vision problems" could be detectedbyparents. Of the 118 "othervision problems" detected during the first 15 years, parents helped find 68. Parents also helped find an average of 1.3 new cases of amblyopia for each of the 15 years, which were confirmed by professional examination. The reported new case rate from the eye doctors averaged one case of amblyopia a year during the same period. Together parents and professionals found 35 cases. The expected number of cases of amblyopia among the 7024 children
screened was 68; thus the results represent only 50% of the expected cases. On the other hand, without the parents' efforts the professional community would have found only 22% ofthe expected number of cases. However, results are dependent on consistent reporting. These results must be interpreted with caution because of possible differences in case definition and underreporting. The findings reaffirm the belief that a home screening kit has merit in involving parents as partners in efforts to find vision problems early when they are most amenable to correction. A 1988 national survey of the states by Lazy Eye Ltd (unpublished) produced 21 responses and indicated that only three states had information on the numbers of cases of amblyopia they had found. Estimates of incidence among preschool children ranged from 0.1% to 6.75%. Three states were also able to provide an estimate of frequency for the total vision problems found, which ranged from 1.4% to 3.1% for the children screened. Only one state had screened almost 50% of prekindergarten-age children. Most states rely on school-centered programs to reach children at risk of amblyopia. The kit and mailing cost are still less than $1.00 per child. However, the program does require the health department to collect and evaluate the findings and provide information to the public and the professionals in Eau Claire. The costs were minimal and did not require separate budgeting. Enlisting the help of volunteers is also essential, to keep costs down and community support up. The materials descrnled in this paper can be obtained at cost from Lazy Eye Ltd. of Eau Claire County, 1521 Folsom Street, Eau Claire, WI 54703. The kit costs ¢10, the Charlie book ¢25, and a "How-to" Brochure ¢15. A video cassette is also available for rental for a fee of $5.00. The time-tested materials and the methodology used offer a good starting point for building a sound program. Twenty years of experience in Eau Claire and the results of the recent national survey underline the urgency and import of the APHA resolution. E John A. Bachanch, M:PH Requests forrepnnts should be sent to JohnA. Bacharach, MPH, 104 East Trunan Avenue, Eau Claire, WI 54701.
American Journal of Public Health 1669
