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Using systems thinking to strengthen a school-based vision program - a case study from the New York City Office of School Health
The School Health Vision Program (SHVP) provides vision services to over 200,000 children in New York City each year, many from vulnerable populations. Although undiagnosed vision issues are an academically-relevant health disparity, with 20% of school-aged children experiencing a vision problem and minority children disproportionately affected, only 41% of students receive follow-up treatment services after a school-based screening. A systems thinking approach offers a means of exploring the determinants of low follow-up, examining the relationships amongst these determinants, and identifying key leverage points within the SHVP to inform improved referral and response practices.
Methods
We used a structured methodology involving problem analysis and individual interviews, followed by group model-building with key stakeholders. Employing systems thinking tools, participants created “rich pictures,” and further analysis through interrelationship digraphs and causal loop diagrams captured the complex web of interconnected factors driving low follow-up in the SHVP.
Results
Key leverage points for intervention include perceived importance of childhood vision care, school involvement and interest, and general community awareness of the services provided by the SHVP. Intervention at these points was identified as fundamental in the effort to improve rates of follow-up and long-term compliance with treatment.
Conclusion
Because a systems thinking approach deliberately includes all stakeholders, previously unidentified or underappreciated leverage points for intervention were illuminated. Administrative, school nurse, and teacher investment in vision screening and follow-up were recognized as currently underutilized drivers within the SHVP. Using systems thinking to better understand publicly funded vision care initiatives provides a foundation for strong monitoring and evaluation practices.
Learning Areas:
Conduct evaluation related to programs, research, and other areas of practiceProgram planning
Systems thinking models (conceptual and theoretical models), applications related to public health
Learning Objectives:
Describe the application of systems thinking tools in the New York City School Health Vision Program
Identify key leverage points for improving follow-up in the New York City School Health Vision Program
Keyword(s): Vision Care, School-Based Health
Qualified on the content I am responsible for because: Emanuela Acquafredda - I am a MPH candidate with a focus in health promotion research and practice. This skills-based certificate includes designing comprehensive, theory-based health interventions and conducting effective program evaluations.
Jill Humphrey, BSN, RN - I am a nurse, MPH candidate, and 2015 New York Academy of Medicine Margaret Mahoney Fellow with a background that includes school-based health care delivery. My son was diagnosed with amblyopia following a routine, preschool vision screen.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.