BILL ANALYSIS Ó
SB 1172
Page 1
Date of Hearing: June 11, 2014
ASSEMBLY COMMITTEE ON EDUCATION
Joan Buchanan, Chair
SB 1172 (Steinberg) - As Amended: April 23, 2014
[Note: This bill is double referred to the Health Committee and
will be heard by that committee as it relates to issues under
its jurisdiction.]
SENATE VOTE : 35-0
SUBJECT : Pupil health: vision appraisals.
SUMMARY : Deletes the existing vision screening requirements
and instead, requires, during the kindergarten year or upon
first enrollment or entry in a California school district of a
pupil at an elementary school, and in grades 2, 5, and 8, the
pupil's vision to be appraised by the school nurse or other
authorized person. Specifically, this bill :
1)Specifies that a pupil whose first enrollment or entry occurs
in grade 4 or 7 shall not be required to be appraised in the
year immediately following the pupil's first enrollment or
entry.
2)Requires the appraisal to include tests for visual acuity,
including near vision, and color vision; however, color vision
shall be appraised once and only on male pupils, and the
results of the appraisal shall be entered in the health record
of the pupil. Color vision appraisal need not begin until the
male pupil has reached the first grade.
3)Requires continual and regular observation of the pupil's
eyes, appearance, behavior, visual performance, and perception
that may indicate vision difficulties to be done by the school
nurse and the classroom teacher.
4)Requires the California Department of Education (CDE) to adopt
guidelines for implementation, including training requirements
and a method of testing for near vision.
EXISTING LAW requires upon first enrollment of a child at a
California elementary school, and at least every third year
thereafter until the child has completed the eighth grade, the
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child's vision shall be appraised by the school nurse or other
authorized person. Requires this evaluation to include tests for
visual acuity and color vision; however, color vision shall be
appraised once and only on male children, and the results of the
appraisal shall be entered in the health record of the pupil.
Specifies that color vision appraisal need not begin until the
male pupil has reached the first grade. Specifies that gross
external observation of the child's eyes, visual performance,
and perception shall be done by the school nurse and the
classroom teacher.
FISCAL EFFECT : According to the Senate Appropriations
Committee, "Vision testing requirements: Potentially substantial
reimbursable mandate to increase the number of required vision
tests, and the scope of those tests. Continual monitoring: The
requirement for "continual and regular observation of the
pupil's eyes" by teachers and school nurses could result in
significant local costs, and could be an additional reimbursable
mandate to the extent that costs could be proven."
COMMENTS : This bill moves up the timeframe for vision
screening in schools so students are tested in either
kindergarten or first grade (whichever year they first enroll)
and again in second grade. The bill does not require additional
years of testing, but simply moves the third grade screening to
second grade. This bill also requires tests for near vision,
which is currently recommended but not required as an additional
procedure in the California Department of Education's (CDE)
Guide for Vision Testing in California Public Schools. CDE's
guidance specifically recommends and describes a Hyperopia test,
which is used for assessing near-distance vision at least once,
preferably in kindergarten or first grade. This bill requires
the CDE to adopt guidelines to implement this bill, including a
method of testing for near vision.
Eye Observation : School nurses and classroom teachers are
currently required to observe student's eyes, visual
performance, and perception. This bill adds the requirement
that nurses and teachers also observe the appearance and
behavior of student's eyes on a continual basis, which is
recommended in existing CDE guidance. Further, this bill
requires the CDE to adopt guidelines to implement this bill,
including training requirements.
Failure of vision screening : Current law requires a report to
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be made to the parent when a visual or other defect has been
noted during the vision screening. Current regulations require
a re-evaluation of a student who failed a vision test, prior to
a report being made to the student's parents. (Education Code
49456 and California Code of Regulations, Title 5, Section 594)
Timeframe : This bill moves up the timeframe for vision
screening in schools so students are tested in either
kindergarten or first grade (whichever year they first enroll)
and again in second grade. This means the third grade screening
is moved to second grade. Several other states require screening
in kindergarten, first grade and second grade, which is an even
more comprehensive approach. Those states include Alabama,
Arizona, Arkansas, Colorado, Connecticut, Washington DC,
Massachusetts, Oklahoma, Pennsylvania and Washington.
Medical Background : According to the American Academy of
Pediatrics, the American Association of Certified Orthoptists,
the American Association for Pediatric Ophthalmology and
Strabismus, and the American Academy of Ophthalmology policy
statement on Eye Examination in Infants, Children, and Young
Adults by Pediatricians, "Early detection and prompt treatment
of ocular disorders in children is important to avoid life-long
visual impairment." It further states that children should have
an assessment for eye problems in the newborn period and then at
all subsequent routine health supervision visits. The policy
statement recommends that "all children who are found to have an
ocular abnormality or who fail vision screening should be
referred to a pediatric ophthalmologist or an eye care
specialist appropriately trained to treat pediatric patients."
Budget Issue : The Governor's May Revision proposed an increase
of approximately $2 million ($1 million General Fund) in 2014-15
(for half year funding) and $4 million ($2 million General Fund)
in 2015-16 and 2016-17 and trailer bill language to implement a
pilot program to expand pediatric vision screenings and services
through the use of mobile vision providers. Under this proposal,
Department of Health Care Services would implement a three-year
pilot program to increase utilization of vision services and eye
glasses to children by allowing a mobile vision service provider
that has an established Memorandum of Understanding with school
districts within Los Angeles County to contract with managed
care health plans in Los Angeles County for the provision of
these vision services at school sites. This issue is currently
being deliberated by the Budget Conference Committee.
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According to the author, "Currently school nurses only screen
students for distance vision. Senator Steinberg believes that
statutory authority is necessary to allow them to be trained to
screen for near vision. In addition, SB 1172 ensures that there
is uniformity of training and methodology by requiring the
California Department of Education (CDE), to adopt guidelines to
implement the near vision screening."
"The author believes that near vision deficiencies may be
interfering with a child's ability to read. Research has shown
third grade reading scores are highly correlated with later
academic success. Some research indicates that reading
proficiency at the end of third grade marks the transition for
"learning to read" to "reading to learn." While the primary
factors that led to low-level of reading skills among low-income
children were socioeconomic factors and the studies found that
preschool programs reversed this trend, the lack of health care
was also identified as a factor. Lack of health care could
result in undiagnosed vision problems."
The author further states, "This bill also codifies the
timelines that are in the CDE guidance, but specifically
requires testing at K or 1, depending on entry grade, 2, grade 5
& 8. This is to ensure that vision deficits are identified
before this crucial grade three milestone identified by the
research as the turning point for learning and during the key
intervals that a child's eye is developing. The additional
testing, especially grade eight ensures that vision deficits are
identified before the child goes to high school. According to
staff at the Board of Optometry, this screening is within the
scope of practice of a school nurse and the bill would require
guidance to be provided by CDE. Nothing would alter the
recommended referral procedures if a deficit is identified."
Previous Legislation : SB 430 (Wright) from 2013, which is in
Assembly Health Committee, deletes an existing requirement that
upon first enrollment in a California school district of a child
at an elementary school, and at least every third year
thereafter until the child has completed the eighth grade, the
child's vision to be appraised by the school nurse or other
authorized person, and replaces it with a requirement that, upon
first enrollment in a private or public elementary school, a
pupil receive a vision examination from a physician,
optometrist, or ophthalmologist and requires that screening to
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include a test for binocular function, refraction, and eye
health.
AB 1095 (Wright) from 2001, which was held in the Senate
Appropriations Committee's suspense file, would have required
every child to undergo a comprehensive eye examination by an
optometrist or ophthalmologist within 90 days of entering the
first grade.
AB 1096 (Wright) from 2001, which died on the Senate Floor's
inactive file, would have
established a three-year pilot program to provide comprehensive
eye examinations for poor
readers.
SB 606 (Vasconcellos) from 2001, which was held in Assembly
Appropriations Committee's
suspense file, would have required the existing student eye
examination, conducted upon
enrollment and every third year thereafter through 8th grade, to
include screening for binocular
function, ocular alignment, ocular motility, and near visual
acuity.
REGISTERED SUPPORT / OPPOSITION :
Support
American Civil Liberties Union of California
Junior Leagues of California State Public Affairs Committee
Opposition
None on file.
Analysis Prepared by : Chelsea Kelley / ED. / (916) 319-2087