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>>> Welcome everybody. Robbin, is it possible for you to hit record?  
>>Hi everyone. My name is Megan, since January 2015 I have been serving as the initiative lead for both early identification referral as well as family engagement at the national center of deaf blindness. I want to thank you all for joining us in this first of a series of four webinars happening across the course of this academic year, related to the four targeted systems integral to the early identification application process which are Committee program, Part C, medical system and Eddie. This is the community program webinar where you will have the honor of learning about an innovative program in Kansas called KanLovKids. 
>> Joining us today are Dr. Anne Nielsen  from the Kansas State school for the blind, Sarah Seagull from Lion County Infant/Toddler services and Dr. Linda Lawrence a pediatric ophthalmologist who is joining us from Peru. We are praying that  that her connection works throughout this entire webinar and she is taking a step away from her vision clinic to join us.  
>>These lovely ladies will be sharing with you the genesis of this outstanding program and the resultsyeilded for increasing outcomes in the state.  
>>Let me give you a few housekeeping items before I toss it over to these smart women to tell you that this webinar is being recorded, you heard this meeting is now being recorded announcement and it will be archived on the NCDB website for future sharing.  If you want to be listened later you can go to that and listen or if you like to share with others feel free.All participants joining us today have been muted to reduce background noise to make it easier for everybody to hear the presenters. If you have a question, I ask that in the lower right-hand corner you will see a chat pod, if you type your questions in there, I will monitor the chat pod while the presenters are talking. We will be interrupting them from time to time to make sure that they get questions answered.  

>>> At the end of the presentation we have saved time for Q&A where you will be able to*six your phone to unmute and ask additional questions that you would like to ask of the presenters.  
>>Finally at the very end in order to ensure that the webinar that we are providing this year are meeting your expectations, we will put up a few simple polling questions at the end to get your feedback about this and future webinars.  
>>Without further ado, I am going to introduce to you to Dr. Anne Nielsen who will begin the  presentation and talk to about this wonderful program.  
>>Thank you Megan.  
>>Welcome to all of you this afternoon I am glad you could join us. We are excited about talking to you about the Kansas Lions statewide low vision program. We call it the KanLovKids for short.  What I take away from this webinar is I would like you to think about how the medical and educational staff working together can make a difference in the lives of children, their parents and the service providers. We hope that is what our program does.  
>>I wanted to let you know that I work at the Kansas State School for the Blind which is in Kansas City, Kansas which was established in 1867. We have a superintendent whose name is Madeleine Burkindine . She is also the superintendent of the Kansas State school for the deaf which is an Olathe, Kansas. That is the structure of how our clinic is orchestrated.  
>>For the KanLovKids program  it is a collaboration between a number of groups. The first of course is the Kansas State School for the Blind. We consider ourselves the anchor organization. We do the core dating of the programs and administer it. Then there is the Kansas Lions, more specifically the Kansas Lions Sight Foundation who really have helped to start the program. They provide funds for us, they give us $10,000 a year to help with the evaluation cost and they are the backbone of the program. They are there to help the clinic and they are there to support us in any way that they can.  
>>The Kansas ophthalmologist are part of this program. Dr. Lawrence who you will be hearing from is a part of that group and she keeps in informed about our group and what they need to know about what we do.  
>>And the Kansas Optometric Association. Most of the optometrists in the state of Kansas belong to this organization. One thing that we have done with them is every two years we have a joint conference with them. The doctors are there and the teachers of the blind and visually impared mobility specialists  they all come together every two years and we bring in speakers that we think will make a difference in what is going on in our field with vision and that will keep us up with where we need to be.  
>>The next slide, I am going to go through real quickly the program history and highlights, who the children are that we serve, who and where the doctors are located, how the clinics are set up and carried out, how children, parents and team members benefit from participating, and what the components of the evaluation are and finally have reports are shared and the clinic costs.  
>>The next slide talks about the targeted participants for our clinics. We serve children and students from ages of birth to 22 years old and it is children with all ability. We do hope that the child the coast of the program is diagnosed with a visual impairment, we need that information from their eye examination and if they are legally blind there this would be 20/200 with depth acuity and test correction or feel loss of 20 degrees. For children with low vision it would be 20/50 with depth correction and best acuity. And then a large number of children who actually function at the level of blindness and their diagnosis is generally cortical visual impairment or cerebral vision impairment.  
>>Part of the history of our program, the Kansas State school for the blind had a vision clinic in the 1980s. It was primarily out of Kansas City out of the school for the blind and they had about 40 students a year. When I started working in this program 11 or 12 years ago. I met Linda Lawrence and also  David Lewerenz , they really inspired me to think more how we could serve students especially in a rural state. Dr. Lawrence was animated about seeing children in their communities where they did not have to travel to one side of the state to get a vision clinic.  
>>Dr. Lawrence had been working with children with additional disabilities, very complex kids, for a number of years, as she told you she has done a lot of mission work she has a lot of experience. These are children in our clinic that we were not serving, we were looking at infants, toddlers and children with complex needs.  
>>In 2005 the superintendent at the Kansas City -- Kansas State school for the blind decided to put together a task force. He invited Lions and doctors and educators to meet and the goal was to design a regionally based model utilizing the expertise of low vision specialist or doctors, and they would be committed to developing a community of practice approach and it would be facilitated by KSSB. 
>> After the meeting superintendent Dority sat down and wrote out all of the information that he had gained from this gathering. He came up with a plan. This was the plan that we look at every year and we try to update. It is the first thing that they wanted done was to conduct a statewide survey on the low vision needs in Kansas in 2006 which we accomplished.  
>>Then anyone who was a part of the program and follow the principles of a community practice approach in the continuing improvement process. They wanted us to develop a reasonable commonality of fees, forms, evaluation procedures, reportage and follow-up. I think that one is one of the key things that has made a difference in this program. We wanted to make sure that a child would get a comprehensive eval, it did not matter if they lived in Kansas City or if they lived in a rural small-town on the western side of Kansas. By making sure that the doctors knew what forms they needed, the reportage that they needed to do, all of that would be set in place upfront so that we could guarantee that.  
>>Then they would work together to design and deliver regional training to parents, school personnel and service providers. We collected data and analyze it and the impact of our services. Then we amend an altered agreement as appropriate.  
>>Some other highlights over the years of this program, in 2011 the Kansas Lions wrote a grant and they were awarded the Lions sight first grant, it was the first one awarded in the United States for $71,000. This was through Lions Club international. With that funding it helped us to purchase devices and assessments for all of our doctors across the state. Again, we could guarantee that they had the equipment they needed.  
>>Another part is we did have doctors on staff who had worked with adults, but they had not worked with children. This allowed us to have funds where we could take them to a doctor who had a lot of experience with children, they could go to that Dr., we could run a clinic and they could coach them on what you need to do with the children, what kind of devices would be good to use. That was really a helpful process.  
>>Also leading the student personnel, the school and the Lions know. I will talk more about somebody [ Indiscernible ] that was used to make webinars. I will talk about that later.  
>>(12:03) There were also several publications and presentations that we did about the program. Probably the most notable thing that happened was in 2014, the international agency for the prevention of blindness recognize the KanLovKids  program on world sight Day as a featured program for North America. With that background information, I am going to start going into a little bit about our program.  
>>Of course I think what makes this program just so unique is that we have doctors in the state that have become a part of the community of practice. This is a picture of all of our doctors, Dr. Lawrence will be on the top right. The other pediatric ophthalmologist that we have that work with our program is Dr. Marie Katoritz who is on the bottom right. I think it is unique to have pediatric ophthalmologist in the low vision program. The other doctors there are optometrists. This is another way of presenting the information. We have 11 doctors in 10 locations, that just outlines who they are and where they are located.  
>>This is a map. The map will give you a better idea where all of these doctors are located. One of the things that the committee wanted to make sure of to make sure that parents and not have to travel more than two, 2 1/2 hours to get to a clinic. We strategically named these plans so we could make sure that they could get to the clinics in an easy fashion. With the next slide, I am going to turn this back over to Megan.  
>>This is Megan. We thought it would be interesting to show you the Kansas deaf blind project child count by region to reflect the 2015 count to show you where the kids are located. As you can see, the yellow circles with numbers are indicative of how many kids are in that portion of the state. As you can see the highest concentration for the state of Kansas is in the northeast and the Southeast. Then we have a few in South Central, it is looking pretty  sparse in the northwest corner who experience combined hearing and vision loss.
>>I am really glad that you added this map into the program. One of the things that I forgot to mention when I was talking about our pediatric ophthalmologist, Linda Lawrence is a unique position. We will travel, if they can find five children in an area we will travel there. We do not set our clinic in the start areas, we will go anywhere.  
>>Sometimes our criteria to the clinic stretches if they have to have a visual impairment, if there are children at risk, we know in that birth through three area there are a lot of birth factors. It is a time that we can educate people, we can bring children into the clinic and we can really talk about that and look at the early identification fines and see if that child may have a visual impairment. It is a time that we could use to educate.  
>>This is the last slide before I turn it over to Dr. Lawrence, this will tell you about how we set up our clinic. We do have a website, a KanLovKids website  that you can go into, I have the address on top. With this teachers can go in, usually the clinics are set up by teachers who are blind and visually impaired. We have about 55 teachers across the state in different regions and they can help set up the clinic, they are certified orientation ability, later on you will be hearing from Sarah who is an early intervention person who set up clinics for their early intervention programs.  
>>If they call and they want to have a clinic I can refer them to this website and they can go in to that and there is a forum section and they can go in and download the forms. They can download the forms, they can give it to the family so they can fill the forms out with all of the information. We needed medical information. They returned those back to someone at the school for the blind and they will put them in the student information system.  
>>Then the doctors working with that clinic they can go into the system and review all of the material before the clinic. That is the way that we set it up.  
>>Everything can be driven from them. I have set up the clinic, usually if it is in a local area the local intervention person will help set that up. And then Dr. Lawrence and I will get in our car and bring our assessment tools and we will go there. The clinics are about in hour long each, they are either in hour, an hour and 15 minutes each. That is how we set it up to get the schedule ready to go.  
>>The other thing on the website, you will notice there are training videos. That is something that if you have time I would like to look at. With the Lions money we were able to develop a number of webinars that are around the topic of low vision. If you are an early intervention person which is what this group is geared to, Dr. Lawrence has done one on the spectrum of optic nerve hypoplasia, Dr. Tess McCarthy has done one on what every teacher should know about visual impairment, we just had Dr. Deborah Chan from California complete a video on vision screening for infants, and Dr. Wendy Staff completed one on emergent optical device use. Those are pretty much geared to younger children.  
>>Cindi, from the chat asked How much is the fee? I was going to cover that at the end. Is that okay if I wait until the end? It is not a quick answer. I have a slide at the very end that I will cover the cost.  
>>Also, the other thing on the website is we do have vendors that if students are prescribed a low vision device, we have a company that is a state contract, the school and the parents can actually buy the device for the family or for the child at cost. With that, Linda, I'm going to turn it over to Dr. Lawrence for the next few slides. Linda, you can give feedback on anything you like.  
>>Thank you very much. Welcome to all the attendees. I apologize in advance, I am at a school near an airport, if you hear airplanes, dogs barking or children I apologize. If you can't hear me, since I am in Peru, let us know as soon as possible.  
>>First of all, this is a real treat to be involved in this process. I can tell you I remember the days when Bill [ Indiscernible ] and Anne Nielsen came and sat on the bench in my waiting room  and said we have this idea. That is how it all started, looking at what exist. I always encourage those of you who are trying to set up some type of a program like this to look around and find your partners.  
>> Anne and Bill look hard around the state for doctors who have a passion for this and an interest, and because of that in the school for the blind and other partners we were able to build because of these programs. I would say to all of you in your area you probably have some very good passionate people who want to work with children and babies and would be glad to partner with you and programs that work with your community and state. From what I know working internationally is that every community, every state is a little different, there is always something very good that you can build on. I really encourage you to look around and see what exists and build on it.  
>>These are just some examples of where we might hold a clinic, its really a variety of sites. We have had local teams help us find where the best site will be to bring in children. For example I may see 5-7 children from a day in an area and its hard for us to  travel to the home in each individual city. We may use a local co-op or local optometry or ophthalmology office or local infant/toddler programs. We let our local host help us find what will be most accessible for the children and the families.  
>>We are able to make some home visits and it is a real treat to be invited into a family's home to help with the  form with their babies.  
>> This is Dr. [Indiscernible] with one type clinic, you can see the young lady [ Indiscernible ] has  reading devices with him. In a clinical type situation low vision optometrists have standardized equipment through the Lions grant. A lot of planning and organization that they did so that each one of our clinics can do the best assessment and find the best devices that are available.  
>>We call the other clinic the pediatric low vision collaboration clinic. It is really meant to be more of a conversation about the medical, the educational, the visual, the developmental challenges with the child and the team might have. It is usually a little more informal. I have to tailor the  examination to each child we may have from babies to 18 and 19-year-olds and we have to have a variety of tools and testing materials to work with mainly children who are nonverbal and have multiple other challenges, many with cerebral visual impairments or optic nerve hypoplasia. We have to be a little creative in our approach to keep it standardized.  
>>Again, we hosted our co-op to help get them familiar with the types of clinics and they can always call Anne or me  for what clinic would be more beneficial for the student. Often we cross refer. For example if Dr. [ Indiscernible ] or Dr. --- had a patient that they felt like needed more of my intervention with cerebral visual impairment, they would refer me and vice versa we have many children who have additional challenges and visual impairment that would benefit from low vision devices and basic low vision assistance.  
>>We work together as a team across the state again with [ Indiscernible ] mobility experts, and Jim [ Indiscernible ] across the state work closely with us.  
>>We use the local people who are there whether it be [ Indiscernible ], early childhood educators, persons who work with students who are deaf and blind, we can access whoever is involved with the students education to have the become a part of the team and be a part of the evaluation. It works better to be there especially with children who are real challenging so that I can actually show the team and the family what that means and what that means as far as overall development and education for the child rather than putting it on the form where you know how language is not always describing what we really mean as hard as we try. 
>>[ Indiscernible ] birth to three with complex learning needs. We asked the parents and the team  to think about what questions they want answered. Rather than doing just an eye exam, I am there to answer questions about the complex needs of the child. They often bring natural materials that the student might be using or the baby might be using and especially other things like they will bring trays or fishing equipment because of course you want the child comfortable and ready to work with us. Which they can't if they're not properly conditioned or if they are hungry, sometimes we have to be careful because our students have seizure disorders and it makes it difficult for us to do an evaluation.  
>>I spend a lot of time reviewing the medical conditions because a lot of times there are questions about medical conditions that really do apply to what happens to the child in the educational realm. Part of the example with optic nerve hypoplasia just knowing that the kids don't sometime sleep and their behavior is  forward. Or what a seizure might be like, or different kinds of things that you may have questions on.  
>>I think Anne is going to talk about  expanded core curriculum and I will jump back in with a few slides.  
>>Thank you, Linda.  
>>Linda has explained that the clinics are really driven by the questions that the parents bring in and the teams bring in. Of course with the medical expertise, Linda can look through a lot of different information, she is a medical doctor and it really helps to take that information and make it functional.  
>>One of the things, the feedback that we have received from people who have gone through the clinic is that they really love the suggestions that come out of the clinic. It is really a unique type where you can spend an hour, an hour and a half together with the educational team, with the parents, the child, you have the information from the medical right there with you so you can get your questions answered with regards to how that fits in with what we are trying to do with our outcomes, with the family outcomes. I think that is one of the strongest things that comes out of these, the suggestions for intervention.  
>>Then we can talk about modifications of the child's environment. Maybe it is an issue that they want their child to walk and there is problems with mobility and they can talk about how educators can come up with strategies and Dr. Lawrence can say [ Indiscernible ] and you need to know that. It helps to put the information together.  
>>The referral for additional assessment, that could be that Dr. Lawrence might think that they need other medical follow-up. It could be for educators, in the field of vision we talk about the expanded core curriculum, the ECC  maybe they need to maybe have an evaluation so that we can learn more about how that child sees.  
>> Many times we will find out that the child has a hearing impairment and they did not know there was such a thing as having a hearing and vision impairment that would make a dual sensory impairments. There are people in our state and across the nation that know the strategies, there are organizations that can help with that. It is the time that we can refer them onto our Kansas DB project to get some help with certification. We also have in Kansas a deaf blind fund where there is funds available if you are certified deaf blind. We can pass that information on.  
>>Most of the suggestions that I was talking about is vision professionals. We really try to apply that within the frame of the core curriculum. If you do not know what that is this is a really short definition of it, it defined the concept and the skills that often require specialized instruction with children or students who are blind or visually impaired, in order to compensate for decreased opportunities to learn incidentally by observing others.  
>>Even in this webinar today you can taken so much information at a glance. If you have a visual impairment you may not have access to. When you think about the expanded core curriculum area, a good example of it is if there is a child learning how to read, but they are blind and they are not able to see print, with the standard core curriculum we could teach them braille so that when they go into the regular classroom they would know -- they would have the tools to learn to read. We can do that with the various areas and the expanded core curriculum.  
>>What happened? I am sorry.  
>>This is about the expanded core curriculum. There are nine areas, there is one in sensory efficiency, at these clinics we look at the vision, but we talk about a lot of the other senses that might be predominate for that child. There's independent living, we talk a lot about how the information that they get from the clinic that day may fit into a routine so we can help the child to be more independent or to use the vision better. There is leisure recreation where we talk about play, likes and dislikes and motivation. What would make that child whole of their head if they had something to look at? Self-determination, making choices, problem solving, controlling their environment. Compensatory being able to play. With career education, expecting them to participate with us. If I hold up the bottle rather than giving them everything, to have them reach for it in an area that they need to learn how to use the vision and to use their eye hand coordination. Social skills is huge with interactions and communication. And how vision plays a role in those two areas. And making it a positive experience for them and really to use what skills the child has, what vision skills they have or other sensory abilities that they have. And of course orientation mobility where they can move or travel safely. And with assistive technology. That may be talking about active learning strategies or using low-tech ways to get them moving or using the iPad. That is something that kids usually navigate.  
>>I will talk a little bit about this and then I will turn it over to Dr. Lawrence. One of the benefits of this clinic again is the medical and educational professionals being able to interface and share with one another and having a conversation.  
>>This clinic is not a one-time thing, we expect children will go through this clinic throughout their school experience. They may come this year and the doctor may want to -- them to come back in the following year or in three years. We do want to see progress. Also medical can change, it is a way that we can update each other about that.  
>>I think it helps parents and the teams to understand the visual abilities and to give them the right support at the right time as the changes are occurring. It also starts with the importance of this is a life long journey that we are looking at. We want children to get access to this kind of information at every stage in their life.  
>>With that, Linda, I will turn it back over to you.  
>>Dr. Lawrence are you back on audio?  
>>Hang on ladies and gentlemen, let's see she got back in on the audio.  
>>Megan,  this is  Robbin, it does not look like she is in on audio.  Are there other sites that Anne can cover ?  
>>She is going to keep on going.  
>>I am not Dr. Lawrence. You will love her. I can answer some questions.  
>>No questions just keep going.  
>>I will just go through this next slide, this is the part that Linda was going to talk a lot about, this is kind of the sequence about how our clinic looks. When the parent comes in we do an interview right away, it is not so much a formal interview, it is really what questions the parent or the team brings. That is what we want to focus on, that is the most important part. We do not want the parents to leave the meeting or the team to leave without feeling that they got answers to questions.  
>>We talk about those questions and that is the time --  
>>Are they back on?  
>>Can you hear me now?  
>>Yes.  
>>Yes we can.  
>>Do want me to go ahead and jump in?  
>>Yes that would be great.  
>>That thing that we really want to emphasize about these clinics is the importance of the answering of the family questions. Often our families, many of our kids are so complex that they really don't understand the visual or the dual sensory problems and how this might relate to the education of their child or the development, nor what the interventions really mean.  
>>By doing the assessment with the family and the team, for example back to the visual acuity, a big question is how small can my child see? And the visual field examination is also really important because often children exhibit mannerism because of visual field loss that has gone undetected. Once the visual field is recognized, strategies can be planned to help the children maximize their movement in space, authority to read etc.  
>>Also again another thing that is not measured is contrast. That is so important starting from a baby were the face is low contrast in motion, if the baby cannot see their mother or caretaker space because of poor contrast ability for what ever eye condition or visual impairment there may be, this could interfere with bonding and munication between the baby and the chair.  
>>We can teach strategies to the parent and give parents support through education of the team on how to address these issues.  
>>In the older child it may be more significant, for example I always remind our interventionist and parents, until you prove that a boy does not have a color vision deficiency between red and green choice making. That sounds easy but you think 8 percent of boys have color vision deficiency. If you're using red and green for choice making they may be set up for failure. Often we are addressing things that we forget to mention in the report as part of our regular examination.  
>>We also do some different things with the children, especially looking at accommodation. Accommodation or the ability to focus near and focus from distance to near is another visual function that is often not measured in an ophthalmologist or optometrist office. This is routinely measured because by finding out that the child has difficulty with accommodation we can prescribe what we call plus lenses which are refraction and what we measure the prescription for the glasses. Then we get additional [ Indiscernible ] plus prescription that helps with that difficulty in seeing near. When we do prescribe glasses that are for the treatment of a visual condition or low vision we want to be very careful to explain to the parents and the team what the glasses are for. For example in a baby if they are for of up close and they're plus lenses, you need to be very sure that everyone understands that. Then in children who have other visual needs, especially in the classroom, we have to be sure we are addressing when we're perscribing devices that, not always been near vision but also the intermediate vision, again, something that is often not addressed in the routine evaluation in an ophthalmologist or optometrist office.  
>>And all of the assessments that we have you want to be able to sit into an educational plan, either a ISSP, IEP, 504 or whatever educational plan, whatever the student may have so that everybody on the team is aware of what the visual condition is and strategies are to correct that.  
>>This is Dr. [ Indiscernible ] with a young man and you can see him interacting with the student. We're not there to steer them to do a medical test and we have to reassure kids that we are a friend and we are trying to help them and he is establishing rapport at the beginning and that is so important. Then we can proceed with a variety and different types of testing depending on what the need may be for the student and the questions for the parent and the educational team.  
>>This is a young man who is in a wheelchair and yet [ Indiscernible ] you can see his hand is able to lift up so that he can actually point to [ Indiscernible ], this was the way that we could check his visual acuity. You can actually determine a mirror and determine visual accuity and this was held in a classroom study.  
>>You can see the baby in the upper right who is on a mat on the floor with his mom and we are looking at the way he is observing and interacting with the toy. Again we are not just sitting in a desk in an examination chair, which is the nice thing about these clinics is we can get down on the floor with the baby if we have to to observe them.
>>On the lower left you can see the doctor working with a young man with a low division -- Globe vision device. And down on the right there is a babysitting on mom's lap and I am using the iPad which we found in some cases is a very useful tool to get visual attention, sometimes if the child has [ Indiscernible ] skills.  
>>We use a variety of things to test visual acuity. You can see here in the upper left this young man is actually able to do letters even though he is nonverbal. We always expect that our students can do a lot and we use a variety of testing tools until we can find what works for them.  
>>The little girl in the middle is using the [ Indiscernible ]puzzle  which uses the matching concept of four symbols, circle, house, square  and heart and we use that to assess many things including if the child has concrete or abstract concepts and also training the child  to understand what these figures are so that we can check national visual acuity which is the child on the right-hand side of the screen, what they can match, even if they can only match one symbol we are able to check their visual acuity.  
>>If the baby cannot match, then we use a paddle which is in the lower picture which is another way to assess the visual responses of the child. The important thing being putting the paddle in the area of the child's visual attention.  
>>We measure in a variety of ways depending on the age and ability of the child. The one you can see on the left hand side, I am not sure what he is doing, on the right-hand side you can see I am poking a ball out behind a black board and the child is pointing to the object as it comes. It is difficult to check the visual field in small children and nonverbal children you have to use a variety of tools.  
>>In content sensitivity as I mentioned earlier it is so important for communication. If a child has poor contrast and cannot see the teacher the moms face it sets them up for a whole set of behaviors that may be misinterpreted as destructive behavior or behaviors that look like autism or just not paying attention. This test is so important. We use the [ Indiscernible ] test for the nonverbal children and we look for the response that the child has or eyes to move towards [ Indiscernible ].  
>>With this once we get down to about a 5 percent contrast we can move backwards and then we can let the team know how far back the child is able to see. Again these are explanations but it really helps if a child cannot see and we build another strategy for the child.  
>>We are able to do a variety of different types of color vision testing depending on the age and ability of the child. This is a more complex tool. This is a test developed for colored vision testing, but also for color place, if a child can trace, they do not have to know the number but they can trace the number and we can evaluate color vision.  
>>Refraction is what I would consider the most important part of the evaluation and it should be something that every ophthalmologist and optometrist does. The little girl in the upper left you can see has trial frames on and we have a variety of trial frames that we carry with us and we are able to actually assessed at the time whether the child could benefit from the glasses. We can look for visual attention, we could  look for [ Indiscernible ] and we can measure the acuity before and after putting the glasses on. Over on the right-hand side you can see the doctor is doing a more formal examination for an older child.  
>>We have a variety of glasses that children can wear and the glasses again it is so important that the family and the team know why the glasses were prescribed and what the use is and that the child is supposed to wear thembecause they have a condition like [ Indiscernible ] or [ Indiscernible ]. We really like to be certain that the family and the team understand why they need the glasses.  
>>I'm going to turn this back over to an to talk about the number of children. What I want to mention is what we have seen and our caseload since the beginning at the clinic is about half of the kids have not only low vision but additional disabilities, that is the importance of having two different types of clinics, one where we have low vision and low vision devices for children and students in a more  academic environment where we may have other kids who need vision intervention and other intervention [ for conditions like cerebral visual impairment that are quite complex. 
>>Anne  I will let you jump in .  
>>This shows you the statistics from the last 10 years. You can see our program has grown. This was a phenomenal year because the Kansas Lions foundation gave us over $100,000, they are really into supporting this clinic with us which we totally appreciate.  
>>I am going to talk to about the report and the cost. The reports are sent out for the low vision clinic that day, there is a systematic easy report that the optometrist have designed and it is on the database and they can fill it out and we can get the report out. That was one of the things that we wanted to make sure happened is they got the report right away.  
>>With the pediatric low vision collaboration clinic, those forms are so individualized, every person is so individualized it could take one, two weeks, it depends. They have to do a lot of details. As Dr. Lawrence can tell you they put a lot of effort in to that to individualize it.  
>>The going rate for the evaluation for low vision evaluation is $250. Low vision evaluations are not covered by insurance. That was one of the main reasons that we wanted to have this clinic in our state because it was a real gap for students not getting the services that they needed because there was no way to pay for those evaluations.  
>>The  KanLovKids  doctors who are a part of our practice, we will knock off $100, we love working with students, we have a passion about what we do, it is not about the money, we will knock off $100.  
>>The Kansas Lions sight foundation said we will pay $100 of that money toward every evaluation. The remaining amount left that the school districts pay is $50 per student to go to the clinic. Actually we really love this formula because we feel that it really brings ownership to the program when there is an investment for all of these different parties that come together, that I think is making a difference, it is not just free or somebody is owning a part of it.  
>>For infants and toddlers, that is a little harder to get. The Lions decided that it is such a critical age group that they said we will pay for those evaluations.  
>>We have written grants in Kansas through the Kansas Department of Health and Environment and different sources to help fund  those clinics over the years.  
>>As far is the low vision clinic evaluation data, I talked about a survey that we did in 2006 to find out what the needs and Kansas were, 85 percent of the teachers of the blind and visually impaired in Kansas said 58 percent of the students with low vision were not getting access to low vision evaluation. That was pretty shocking to us to think that almost 60 percent of the kids were not getting an evaluation.  
>>With this community of practice every member of children who received evaluations before the inception of the KanLovKids program  was approximately 40 students per year, primarily in one location which would have been Kansas City which is way on the east side of the state. Over the last 10 years 1,244 children have been evaluated with an average of 124 children and units per year going through. This represents an increase yearly of 210 percent.  
>>We really feel that this really makes a difference. We feel that it is a program that could be replicated to other states. I know Linda has used this model in many of the different places that she has served in the world.  
>>I just had a recent call from Nebraska saying we cannot go full bore on this but we can start small. They are going to start in one area of their state.  
>>For more information you can contact me, my number is there. Also Aundrayah Shermer she is outreach director for KSSB.  And also the Lions Club you can get information from Lion Sylvia about that.  
>>The next person that I'm going to put on to talk to you is a person who has been a part of this program in her role as an occupational therapist at the Early Intervention Program that I have been fortunate to work with. I will turn this over to Sarah.  
>>Thank you,  Anne.  
>>My name is Sarah Siegel. I occupational therapist that works with Lyons County  in the toddler services. Dr. Lawrence and Dr. Neilson have asked me to share about the value of the program working in collaboration with the infant toddler service program and how it helps us better support our family.  
>>I work with a team of therapists that include physical therapy, social work, nursing, speech and language therapist as well as early childhood special education teachers. We work in the community to serve children between the ages of zero and three years old and their families.  
>>We provide targeted therapeutic services as well as helping those families connect with resources in the community and supporting them to advocate for their child and for their families needs.  
>>Part of our program we use a team approach to help to meet the needs of our families. Part of that includes vision services. We are very, very lucky, we have pretty wonderful TVI's in the district that we get to work with Dr. Lawrence and Dr. Neilson in the community and that helps to boost the support that we are able to give our families.  
>>Over the years we have had multiple children go through low vision clinics and so far the families than I have worked with have been so grateful to have that information and have those insites provided through the clinic.  
>>During these clinics one of my favorite things, Dr. Lawrence always starts off by introducing herself to the family and asking, what are their concerns and priorities, have they noticed anything different with the last eye report that the family wants her to know about and really gives the family a good opportunity that their voices are heard.
>>And they go into other medical appointments with the family, I know this doesn't always happen but I really appreciate that.  
>>Sometimes families get their reports and oftentimes they have difficulty translating that information into really practical and functional information that is useful for the family in everyday life. Both Dr. Lawrence and Dr. Neilson do a great job of breaking down the information for the family in a way that is easily understandable and can give them some examples of what to look for during those daily routines. They are also giving insight into what the parent should be looking for in the future as well.  
>>For example if we see certain visual behaviors, what that could mean for the child and also another example like if a child has a history of ear infections, we can work on making sure that we are monitoring their hearing and keeping them on the radar for a possible sensory loss.  
>>It's also a good opportunity for us to get prescriptions for things like new eyeglasses or if they need patches, this is especially helpful because kids sometimes only get to have that ophthalmology appointment once or maybe two times a year.  
>>The information shared to these clinics is really helpful to ensure that the infant toddler team that includes the district TVI's is following all aspects of the visual condition, that might be affecting the child or the family.  
>>Dr. Lawrence and Dr. Nielsen  do a good job of providing evidence-based articles as well as intervention strategies, if they are on site with the family, but also in the follow-up report.  
>>They really are an invaluable resource for the professional team as well as to our family.  
>>One of the best examples that I can think of for how our families have benefited from the collaboration with Dr. Lawrence and Dr. Neilson through the low vision clinic, it starts with a little girl with optic nerve hypoplasia . I was new to the team and even newer to the condition of ONH. Dr. Neilson -- Nielsen  and her team credited me with articles on what it was just to give me a starting point for how I could better support the family. I was still feeling pretty lost. While I felt like we were addressing those primary vision concerns I really felt like we were spinning our wheels because she was so sick, she missed a lot of visits, she was in and out of the hospital, and the family did not appear to be too confident in being able to advocate for her medical needs. I did not feel confident in my ability to support the family in that journey because I was so new to the condition.
>>Through the low vision clinic, Dr. Lawrence brought it to my attention that many of the symptoms that she is expressing could be associated with the condition of ONH. Because the medical care team was not communicating well with each other and the parents had difficulty sharing that information with all of the different providers, and there were a lot involved, there were likely things being missed. That was the case with this little girl. Dr. Lawrence helped me to create a form that the family could use to track all of her baseline vitals, her signs and symptoms, and her medical history and everything that was related to her learning. It included various conditions associated with ONH. This was used to help the parents and reallyall the providers involved with the child better understand her condition, but it was also something that the family was able to take with them wherever they went so they could advocate with their child.  
>>For example some of her frequent ER visits they could use this form to help the doctors be more familiar with ONH and how to best  treat her symptom.  
>>Thanks to the support of Dr. Lawrence, this form is being used by several families in our infant toddler program. I think it is going to be available online soon, free to use for anybody. This is something also that other children transition out of part B services and move to a school base. It is a great tool for the new team to be aware of what is going on with that child.  
>>If this child had not attended this low vision clinic I am not sure that this form would have been created and there is a good chance that those symptoms that she was experiencing could have been missed. 
>>The collaboration with Dr. Lawrence and Dr. Nielsen  through the clinic really does go beyond that one-time appointment. They continually strive to share information and resources with our infant, toddler program and with our families. And we are so very grateful to have their services available.  
>>Thank you for your kind words.  
>>It is a real joy for Dr. Lawrence and I to go and meet the people, the school personnel, the early interventionist, everyone has the best at heart for the students that we work with and the families that we work with. Linda, do you have anything else you would like to add to that part of it?
>> I have a couple more slides.  
>>Just a couple of things to add and follow-up [ Indiscernible ]. The form that Sarah was talking about, someone had a question about how to get it, you can certainly email me, it was actually brought to the American Academy pediatric ophthalmology into business and they thought it was fabulous and it will be on our website as soon as I get organized enough to get it there. If you want that Anne, or I or Sarah  can provide that. It is meant to be a guide but it has great information. And like Sarah said this is an example of the collaboration of the team and the parents also that we were able to address this issue after realizing what a big issue, the help in the classroom of these children is and how much it affects their education. It was great that Sarah and other teachers brought this to my attention so that we could from a medical standpoint address it. That is how all of this really worked together.  
>>Does anybody have any other questions?  
>>Linda, I am going to go through a couple more slides.  
>>Dr. Lawrence is in Peru right now and we are so grateful to the and Sullivan center of Peru for making this work today. And then of course Sarah thank you for your presentation it is meaningful to have someone who has gone through the program. And then Megan I should thank you , it makes me nervous when Megan  is asked to do things, it has been a real joy to work with her over the years. People keep your feet to the fire that are out there in the ranks and wanting what is best for kids. Megan is that person. She drives you to do your best.  
>>This is just information that you can go on and get about the KanLovKids program and things that have been published.  With that we will go to the questions and answers.  
>>Huge thanks to Anne and Sarah and  Dr. Lawrence, can you still hear me? I dropped the phone. Thank you to all of them. If you have questions you can *6 to unmute  your phone and ask questions of these three lovely ladies.  
>>I am practicing a moment of silence.  
>>I am going to chime in. One thing I wanted to say about the model that we have in Kansas it has become an international model. We have talked to people from Africa, India, South America, come and train to look at the way that we interact as a team, not just a specific technique but how is it that we have this relationship. It has been a really great model and we invite any of you to ask us how to help you do this. We set up this model in South India recently and right now we have a very similar model, we have 450 students that routinely do these low vision evaluations and develop mental evaluations on an ongoing basis because it's so affects their education.  
>>This  is Megan speaking. The other thing I want to mention to you is  when I was running the deaf blind project in the state of Kansas, I had completed the self-assessment guide and action planning  process and realize a hole in the child find was related to connecting to the medical community as well as working with Part C closely to make sure that they knew when to refer kids to our program if there was  suspected loss. We actually worked closely with Dr. Nielsen and  Dr. Lawrence to organize vision clinics across the state for kids expecting a dual diagnosis. We were then able, sometimes if it was a part B situation, this was long enough ago that Lions club wasn't paying those $50 our grant would kick in, the cost piece to pay the $50 and we would put the kids or put the child on the registry and provisionally certified until we could get the and the medical evaluation they needed. Having them do the vision first and then add on to the form that they were suspecting a potential dual loss really increased our child find efforts in the state of Kansas. That is why I thought it would be significant for you guys to hear about the program and to think about the fact that if such a thing did not exist in your state, maybe you could think collaboratively about working with the pediatric ophthalmologist to try to host one or two of these to actually do a clinic just for kids with deaf blindness. The deaf blind registry who you already know could get a better evaluation or they could help you on if the child does have a combined loss.  
>>Anyone else have any questions?  
>>This  is Robbin,  Lyn had a question in the chat pod. Dr. Lawrence, I noticed one child with tinted lenses in one of the photographs during the low vision check, do you routinely check to see what tinting may be useful for a child to see more clearly?  
>>Usually that is done more by the low vision optometrist for the kids that have an aniridia or maybe [ Indiscernible ] or maybe retinitis pigmentosa. Those tints  are very specific. It is for medical indication. Occasionally we do have to give sunglasses if the child has photophobia from a neurological condition. That has to be very, very individualized and [ Indiscernible ] the tinted lenses are prescribed that are sometimes inappropriate but these are medically perscribed tinted lenses.  
>>Thank you.  
>>Thank you for asking that question. Any other questions asked --?  
>> See what a good job these ladies did.  
>>What I am going to do is have Robbin put up the polling questions  that I told you we would be posting at the end to give you a chance to provide us feedback. If you would answer the question that you see up on the screen we will give you a second to respond and then we will move to the next question.  
>>Robbin  we can go to the next question.  And I think we can go to the next one. I think there is one more.  
>>While that one is still up and you are finishing that question, I want to take another chance to thank Anne, Linda and Sarah  to share with us today. It helped so many kids including kids with combined vision and hearing loss. I want to let you know that we appreciate you joining and listening to the story about the evolution of this amazing program and how it has grown over the years to create an impact for kids and their families.  
>>I wanted to let you all know there will be four webinars and they will be happening on January 23rd at 12:00 -- Pacific time. It will end early if there are not a lot of questions. Emma Nelson and a team of Part C providers from the great state of Vermont will be joining us to talk about a program that they run in Vermont to help serve and find kids through the Part C system. The login details will be shared on our NCDB website.  Just stay tuned and they will be coming out soon.  
>>I am pretty excited because this is an additional grant that she runs alongside her Vermont deaf blind project. It will give you some other cool ideas in ways in which you can partner with part B to find and get kids refer to your project in your state.  
>>I will wait one more second to make sure there are no more questions for our esteemed presenters. If we do not have any more we will adjourn in a second.  
>>Tran9, I have one question. I am just curious, to Linda, how did you get in touch with them -- with Anne , I know her myself, she is a go-getter, how did she get in touch with the medical community and how did she approach you or did she go to -- or did you go to her? How did that happen?
>>This is a really good question. One of the things that we are doing on a national level is trying to educate our pediatric ophthalmologist about what is out there as far as the educational system. Doctors do not know much about the education system or how important are diagnoses and our input is. We are actually doing training programs for our self to be of assistance. This year we had a big program at the [ Indiscernible ] meeting in Jacksonville to send that off.  
>>What I would recommend you do is to find out in your community who works with kids, who is interested and asked them to come give a workshop or a lecture and you start the relationship.  
>>The other thing is going to eye appointment if you can. I have had many TBI's described to me the first time they went they felt uncomfortable and the doctor was rough and by the third appointment the doctor was friends because the doctor realize how important the teacher was in taking the information into the world of the child.  
>>Don't be afraid to approach the doctors and asked them to be involved with you. What are your questions, we are glad you can lecture, but we need to know what you need to know.  
>>If you want to [ Indiscernible ] and Jennifer Hall is the executive director and she will get you speakers on anything you want. That is the best way to get started.  
>>Thank you.  
>>Thank you for that great question. It also happens to be that Dr. Lawrence is a go-getter and so is Dr. Nielsen. It helped  that they relinquish the envelope and getting good evaluation to the teams. I would add to what Dr. Lawrence said, that was probably of all the things that I had trouble participate in in, in the state of Kansas, the vision clinics were a miracle for the kids that I served because it really was the first time that the whole team would sit around with a medical doctor and ask origins like how are you noticing the child is using their vision at the home or in the classroom, depending on the age of the child. They really worked to walk away with action items on a list that could be taken and immediately implemented either in the home or the school or in the community. It became then a follow-up that I could use with my coaching with the state. My state deaf blind project had to stay -- say to the families are the strategies working and let's have continued conversation. Dr. Lawrence was such a pioneer that there was a time that we were not certain on how one of our students were using her eyes. We took a video while she happened to be in Peru and sent it to her. Within a few hours we had an answer back with how she felt this child was using her vision. It was a consensusbuilding opportunity for us to make decisions about what we needed to do next to maximize the child's residual vision and make the most of what they were gaining in the learning environment.  
>>The partnership has been phenomenal and key element and success for the kids across the state.  
>>Anymore questions?  
>>Can you hear me?  
>>Yes.  
>>I was just going to follow up that it is a two-way street, I just fill so fortunate to be involved in these clinics where I get the privilege of observing a child for an hour to an hour and a half in a doctors office you are talking usually 10 minutes maximum. What the team brings to the doctor is a pretty intense learning experience, educational experience and sharing experience. It really works for all of us in a good way. Thank you for teaching me.  
>>One last call for any questions. You can *6  to unmute if you have one. If not I will let Dr. Lawrence go back to her clinic in Peru and say a big bank. This worked for the connection for this hour and a half from Kansas to Oregon and to all of you across the country who were gracious to join us and listen. A big thanks to all three of them for taking time away from their work to teach us about this cool program.  
>>Hopefully I will see a lot of you guys in January at the next webinar. Very soon the archive of this will be on our NCDB site as well as the PowerPoint  for your reference for the future and I will be sure to follow up with Dr. Lawrence to get that form that she and Sarah used and add that to the early identification and referral resources on the site so you can have access to that and use it in your state if you would like to modify it for your own use.  
>>I hope everyone has a great rest of their day and we will connect again soon.  
>>Thank you.  
>>[Event Concluded]