Thousands of Baltimore students may have eyesight problems that go undetected and uncorrected because of inadequate funding in the city's school-based health system — a problem that leaves many of them at a disadvantage in the classroom, according to a report released Monday.
Sponsored by the Abell Foundation, the report titled "Why Can't Johnny Read?" found that many students are falling through the cracks of the city's school-based vision-screening program, a problem exacerbated by the school system's truancy challenges and its urban population.
"It's a problem everywhere, but it's worse in a poor, urban school system," said Joan Jacobson, who wrote the report. "It's possible for children to go through the Baltimore City school system who have never had their eyes tested, let alone received follow-up care."
Jacobson said the report's findings underscore that the city's Health Department — which provides health services to Baltimore students — is limited in its ability to serve students. The report did not link its findings to student achievement data, but Jacobson said it is "obvious" that poor vision affects how students perform academically.
"You have to be able to see properly to do your work," she said.
State law requires the city to screen children when they enter school, and in first and eighth grades. Last school year, roughly 12 percent of the nearly 21,000 city students who were screened failed their vision tests, the report found. Only 17 percent of students who failed the test documented that they received follow-up care.
In the 2008-2009 school year, 15 percent of 24,000 students tested failed their vision screenings, and roughly half of those students documented that they followed up with a doctor.
The failure rate was higher in the 2008-2009 school year, the study noted, because a change in state law in 2008 no longer required that all sixth-graders be screened, a rule that the report recommends city leaders challenge.
The Abell Foundation, a Baltimore-based organization that researches and reports on city education issues, issued the study after analyzing Health Department data and conducting interviews with school principals and Health Department employees.
The report focused its criticism on the number of vision screeners at the Health Department. Nine screeners are responsible for students at 140 city schools, in addition to 1,600 private-school students, the study found.
The burdens on the small Health Department staff, the study found, make it less likely that screeners will follow up with the thousands of students who are absent when they are due to be screened, or track those who fail vision tests to ensure they receive glasses or corrective care.
In the 2008-2009 school year, 12 percent of students were absent on their designated screening day. Eight percent were absent in the 2009-2010 school year.
School system officials said the report validated anecdotal evidence that students in the city are suffering from a lack of vision care.
"The report gives us a level of clarity around the issue," said Jonathan Brice, executive director for the city schools' office of student support. "Now what we have to do is to work with our health provider and the community to find a way to have these kids' needs met, and put a dent in the number of students who have not been served."
Baltimore's recently appointed health commissioner, Oxiris Barbot, said the study brought to light inefficiencies that the school system and Health Department have to tackle together.
A pediatrician who came to the city in August after overseeing New York's school-based health care, Barbot said vision screening is "certainly an area where we have the opportunity to greatly improve."
"We can certainly introduce efficiencies into the system," she said.
Barbot said the Health Department would try to act on the Abell Foundation's suggestion to improve communication with school principals to ensure that students' phone numbers are updated so that their progress can be tracked. Up to 30 percent of students' phone numbers are invalid, the study found.
"We do recognize the importance of linking vision with good educational outcomes," she added.
Barbot said introducing technology to the vision-screening process is also an area the department will target. The Health Department's vision program is not computerized, the report noted.
"The health aide tracks the students from stacks of papers in her small East Baltimore office," the report said.
City Councilwoman Mary Pat Clarke, who heads the education committee, said she was concerned about the report's findings and would look to the health commissioner for guidance on the costs and processes of strengthening the school-based health service.
Clarke said she suffered from a lack of vision care for years, unable to make out leaves on trees until she finally received glasses in high school. She remembered failing at algebra because she couldn't see.
"I can certainly relate to the effect on learning, because if you end up in the back of the room, tough luck," Clarke said. "These screenings have to happen in school, if it's going to happen at all."
At least one city school has gotten it right, the report noted. Hampstead Hill Academy is highlighted in the report as exemplary in its efforts to ensure students' vision care. In the 2009-2010 school year, more than half of the school's students who failed their vision test were wearing glasses by the end of the year.
"We see it as a school-readiness issue," said Matt Hornbeck, Hampstead Hill's principal. "Just like you need breakfast and a clean set of clothes, you need to make sure that vision is a prerequisite for learning in school-age kids."
Over the years, the public charter school has allocated money to staffing a full-time nurse who can conduct and follow up on screenings, partnered with the Maryland Society for Sight, and even uses its budget to purchase glasses for students — sometimes two pairs, so the student can have an extra pair at school.
"It's pretty amazing, because you'll have kids who, clearly, things improve dramatically when they have the glasses," said Kathryn Sexton, an instructional support teacher at Hampstead Hill. "It makes a huge difference for these kids."
The full report on vision screening can be found under "publications" on the Abell Foundation website, at www.abell.org.