Improving Access to Vision Care for Youth in Foster Care

Statement of Problem

Vision is tied to multiple aspects of well-being including physical, emotional, developmental, and social. Uncorrected vision problems among children can impair learning, participation in extra-curricular activities and social development.

Accessing vision care and glasses can be particularly challenging for youth in foster care. Undetected and undertreated health problems are common among children entering foster care, and they can experience unique health care access barriers during placement. 

While caring for youth in Children's Hospital of Philadelphia's (CHOP) Fostering Health Program, we noticed that many children with abnormal vision screens did not have access to glasses. In research to further understand this issue, we reviewed the charts of 190 children seen at our clinic over a one-year period. Out of 55 patients with a documented history of needing glasses, only 12 (22%) had access to them. We performed eye chart vision screens for 120 patients and 71 (59%) were abnormal. Almost all youth with abnormal vision screens (66/71, 93%) did not have access to glasses.

We also noted that children in foster care face unique challenges in accessing vision care. Fragmented health care and schooling resulted in missed opportunities for routine vision screens. Some children reported their glasses were lost as they entered foster care or moved placements. And caregivers, especially non-relative foster parents, reported being unaware that children in their care needed glasses.

Further, children in foster care are at increased risk for health problems that can be compounded by uncorrected vision issues, including academic delays and behavioral manifestations of trauma experiences such as hypervigilance.

Description

In 2024, our team, composed of Fostering Health Program and PolicyLab professionals, launched a project funded by the Warby Parker Impact Foundation aimed at helping children in foster care access the vision care they need.

As part of this project, patients of CHOP’s Fostering Health Program with abnormal vision screens will receive case management to help coordinate optometry visits, support with associated costs such as transportation, optometry exams, and glasses, as well as help using technology to facilitate ordering glasses.

Multiple systems are involved in delivering care to foster youth including health care providers and payors, courts, and child welfare agencies. In tandem with implementation of additional care supports within the Fostering Health Program, we are speaking to various interest-holders to understand system-level barriers and opportunities for improving access to and continuity of vision care for youth in foster care. This will inform the development of targeted educational materials and policy recommendations.

Additionally, we will measure the impacts of the clinical intervention on access to glasses and multiple domains of well-being. We are putting youth and caregivers at the center of this work, inviting foster youth and resource parents to share their experiences and insights in interviews. This information will be paired with assessment of intervention-related outcomes, such as time to receipt of glasses after abnormal vision screens, to demonstrate the impact of this program and inform next steps.

Next Steps

With this project, our goal is to ultimately improve systems of care for foster youth so they have consistent access to the glasses they need to learn, participate in the activities they love, interact with others, and recover from trauma experiences. Over the course of this project, we aim to:

  • Develop and disseminate educational materials from interview findings and desk-based research to help inform practice across child welfare agencies, foster care agencies, child advocates, vision care providers, schools, foster parents, and additional community interest-holders. These materials will center foster youth and help their support network see the role they can play in advocating for youth’s vision health.

  • Translate our findings into a policy brief and disseminate policy recommendations at the local and state levels to the multiple systems involved in caring for foster youth. This brief will demonstrate the vital importance of vision care for foster youth and explore strategies to mitigate the unique access barriers this population faces.

  • Highlight youth voices and foster parent perspectives on the impact of living with and without vision supports, as well as identifying needs and gaps in the system to identify and sustain the most valuable intervention components and inform future efforts.

As this work has progressed, two new projects have evolved from our work in this space:

  • In a project using visual qualitative methods, we aim to demonstrate the longitudinal impact of improved access to vision care among youth in foster care beyond the health care space.

  • Drawing on the expertise of individuals with lived experience and leaders from child welfare organizations, we will develop a partnership to expand vision screening beyond the medical setting with community-based initiatives to better address the vision care needs of youth in foster care.

Suggested Citation

Children's Hospital of Philadelphia, PolicyLab. Improving Access to Vision Care for Youth in Foster Care [online]. Available at: http://www.policylab.chop.edu. [Accessed: plug in date accessed here].