Project Initiation Document

Project Name:Proposed Vision Assessment Services

Project Reference:

Project Sponsor: Sally Harvey

Project Manager: Ginny Tyler

Programme(s) initiating the project:

Sign off

Date signed off:

Signed off by:

Review date:

Filename/Version:PiD_template_WITH_EXAMPLES_v4_0.doc

Revision Date:02 October 2018

______

1. Overview

1.1 Context

Children and young people do not undergo regular eye tests, despite these being free of charge and readily available through high street optometrists. Although there are some regional variations on service level, there is no national screening service for complex needs children's eye health. At RNIB Pears Centre, despite considerable expertise on site, there is currently no single means of assessing vision and how vision is used.

Where children and young people have additional needs, the job of assessing eye health is far more difficult. The impact of vision on mobility, learning and behaviour is significant; yet it is often deemed secondary to the additional complex needs. Many young people with additional needs are assumed to have had eye testing as part of their wider health care, but this is rarely the case. We need to address thisarea of health to avoid children and young people growing up further challenged by treatable eye problems

The 2007 report ' Children's Eye Health - A report on Vision Screening for Children' concluded that many children are missing out on vital eyecare, putting them at risk of undetected eyeproblems which if left untreated could affectthem for the rest of their life. It states that "It is important that any vision problems areidentified as soon as possible, particularly ifyour child has any other disability (cerebralpalsy or Down’s syndrome) as visualimpairment can cause serious educational andsocial difficulties.”[1]

A 2010 article from Optometry Today suggests still no improvement in terms of regular eye testing for children and young people. They report that a recent Johnson and Johnson study revealed that just 53% of children in the UK have had any kind of vision test, compared to 75% of Italian children and 88% of Russian children.[2]

Because vision and perception impact so much on all of the other areas of development, it requires the knowledge and skill of a wider range of specialist staff to assess the level and degree of visual impairment and how it can be managed and treated.

Rahi and Cable (2003)looked at children newly diagnosed with visual impairment or blindness and found that 48% had CVI/disorders of the visual pathway. They also added that CVI and disorders of the optic nerve were more frequent in children with associated non-ophthalmic impairments than those with isolated VI.[3]

The publication of 'The estimated prevalence of visual impairment among people with learning disabilities in the UK.' [4]concludes that more than 23,000 children and young people aged 0 - 19 with learning disabilities in the UK are estimated to be blind or partially sighted. This means that nearly one in 18 children and young people with learning disabilities is blind or partially sighted. An estimated 88,000 children and young people with learning disabilities in the UK have refractive error.

1.2 Project objective(s)

The objective for this piece of work is to remedy this deficiency in the service at RNIB Pears Centre and in doing so produce a highly usable assessment tool which would represent best practice in complex needs support. Not only would this deliver a robust baseline assessment, but it would provide carers, teachers and other professionals with a package of recommended support to ensure the optimum learning environment for the young person.

An expert group has collaborated to produce a proposed pathway for assessment which;

  • Refines, tests and evaluates the range and content of the functional vision assessment.
  • Agrees the range of clinical medical assessment that is required.

Further work will provide evidence to

  • Establish the competencies, knowledge and training required by those who will assess, record and access findings in different ways and at different levels.
  • Identify the potential for an electronic version of the tool and inform the design of this software

Finally, the proposed outcome of this work is to

  • Agree the specification for the development of the tool in either apaper or software version.
  • Enter into discussions with academic institutions having a strong interest in the testing of vision of young people with learning difficulties about the potential for accreditation of the process.

1.3 Business Case

We want to develop a robust methodology for assessing the vision of children and young people with complex needsat RNIB Pears Centre by the end of 2012. [5]

  • Key inputs to this activity are money and time.
  • Key output is research data to demonstrate the work so far can meet the need of this service.
  • Key outcome is a usable assessment tool for Pears Centre.

Work already undertaken has produced a comprehensive assessment tool which is ready to be tested in a real-time environment by appropriately qualified and supported staff. This has been identified as comprising a Qualified Teacher of the Visually Impaired, a teaching assistant and a senior social care worker holding the RNIB VILD qualification. The author of the assessment tool will be able to provide ongoing advice and support on its use.

Option 1: - do nothing

Advantages: No further cost or other inputs.

Risks: Young people's sight problems not identified fully, reduction in learning opportunity; loss of skills for those staff trained in FVA.

Constraints:Lack of cohesive shared format supports further development of assessment on site; Pears Foundation has interest in the work so may resist not developing the project further.

Potential impact: Young people do not achieve full potential; possible reputational damage when lack of assessment of vision on site becomes known. Potential loss of donor support (Pears, Boots) Potential loss of confidence by purchasers

Option 2: - Carry out a pilot of the vision assessment tool.

Advantages: Provides data to support the future development of the tool. Allows at least 3 young people to benefit from the use of a multidisciplinary assessment and plan. Fits strategically with Goal 5 work stream[6].

Risks: Continued input of key consultants needs to be funded. The compiling of the report will need to be undertaken by the working group and this has cost implications. Risk that serious flaws will be identified and there is no more funding to rectify or develop further. Raises expectations of stakeholders and funders.

Constraints: Needs to fit in to current work packages and in during the move to a new school building. Requires commitment from managers where budgets are critical.

Potential impact: further development of the existing work stream provides external support for the project (academia etc) Allows the tool to be critically evaluated. Brings research interest and potential for funding to the project. Confirms willingness on RNIB’s part to continue the project.

Option 3: Carry out a pilot of the vision assessment tool and commission an electronic version whose development will be informed by the pilot.

Advantages: As for option 2, in addition makes use of the opportunity to link testing with IT development, allowing a very flexible approach to that development.

Risks: As for option 2, in addition this may extend the duration of the pilot and detract from the main task of evaluating the tool. It may cost significant money and this may not translate into a marketable tool at the conclusion. There is no local IT expertise to help inform this part of the project and so would need to be bought in.

Constraints: As for option 2, in addition it may be difficult to find a suitable IT developer who can understand the context and keep costs low. Issues around client confidentiality if bringing in external agencies.

Potential impact: As for option 2, in addition could result in a highly usable IT programme that would attract further funding from donors or academic partners

Option 4: Undertake the pilot and electronic development as part of an academic research project with a partner organisation.

Advantages: As for option 2 and 3, in addition may attract funding to offset local costs, and address the issue of future validation of the tool and training associated with it. Would provide valuable outcome data for publication.

Risks: As for option 2 and 3, in addition this could create delays in the start of the pilot due to the need to identify academic interest, approve ethics etc. There may also be a risk of expanding the scope of the project before consideration has been given to the cost of this.

Constraints: As for option 2 and 3, in addition RNIB would need to invest resources from Evidence and Service Impact team etc which have not so far been explored.

Potential impact: As for option 2 and 3, in addition would provide publicity and further significance to the project at an early stage.

Options appraisal

Option 1 / Option 2 / Option 3 / Option 4
Key Input - money and time. / Nil / £3,600 * / £3,600 + cost of IT consultant / £3,600 + cost of IT consultant but potential for shared costs with partner organisation
Key Output - research data / None / Provides data to inform continuation of project / Provides data and potential marketable software tool / Provides data, potential software and possibility of shared resources
Key Outcome - Usable assessment tool / None / Enables production of final assessment tool / Enables production of electronic tool that can be marketed / Enables production of marketable tool with shared development costs
Decision / Discard / Preferred -outputs achieved with known and controlled inputs / Discard - Potentially more valuable, but cannot be achieved without introducing risk and complexity.

* see appendix A

The plan is to run the assessment with a small cohort of young people from RNIB Pears Centre initially; two resident young people and one day pupil. The work would be undertaken during the second half of Autumn term 2012 and would be expected to take around 5 weeks to complete.

During the assessment period, the assessors would be required to keep a journal to record the activity level, any issues and problems and note any recommendations that they would make to improve the format. The author would be on hand to oversee the activity and provide any advice.

Once the assessment forms are completed, there would be a report and plan drawn up for each young person with designs for the best use of environment, resources and equipment to optimise their learning and development.

Together with the author and members of the expert working group, a report would be produced on the outcomes of the pilot which considered the functionality of the tool, and put forward proposals for future development. This report would provide costs for the use of this model as-is and in other formats. The report would be shared with a team of experts in this field to provide peer review and feedback. These include Maggie Woodhouse, Cardiff University; Alistair Fielder, UCL and Louise Stalker, Action for Blind People, with representation from RNIB VILD services and SeeAbility.

1.4 Benefits / Outcomes

This work fits within both of RNIB's Goal 5 and Goal 7 work programmes; it is one of the Goal 5 projects in terms of the links with improving educational outcomes through early identification of vision problems, and it also has strong links to the Goal 7 vision assessment workstream.

There are obvious benefits for Pears Centre young people, that each has as an outcome of this project a full vision assessment with a corresponding education and personal development plan.

In addition, the potential for external interest in this project would raise the profile of Pears Centre nationally and bring in interest for training professionals to use the tool as well as the opportunity to carry out assessment both on site and as an outreach service.

2. What are the main output(s) this project will deliver

2.1. In Scope

  • A tested assessment tool providing a plan of care and education for each young person
  • Consideration for the tool to be delivered in an electronic data capture format, with a brief for this development
  • A paper, reviewed by Professor Maggie Woodhouse of Cardiff University, Professor Alistair Fielder, Emeritus Professor of Ophthalmology, UCL and Louise Stalker, optometrist, Action for Blind People. This will support the development of accreditation for this tool by an academic institution.

2.2. Out of Scope

  • A package of training and development to offer external agencies to use this tool. This would provide robust quality assurance as it defines the competency level of assessors.
  • A functioning electronic version of the tool which can be marketed to external agencies

2.3. Quality Expectations

It is expected that the preferred option will determine whether further development of the tool is supported by evidence of its effectiveness during the pilot study. This will be reviewed by academics who have expertise and interest in the assessment of sight in young people with complex needs, with a view to developing accreditation for the tool.

The tool must be robust enough to provide clear assessment of the young person's vision. It must also identify a skill set for the person conducting the assessment to ensure consistency. This pilot will critically evaluate the assessment tool and the corresponding diary and feedback evidence will give us data to continue development of the competency set for the assessor.

2.4. Acceptance criteria

The outcome of this project is to produce an assessment of vision for three of the young people living and learning at RNIB Pears centre. It will also produce a report on the usability, reliability and appropriateness of the draft assessment tool in a real-time setting. This will be produced by two team members; a teacher of the visually impaired and a senior social care worker who holds the RNIB VILD vision assessment qualification.

The report will comprise a journal of the activity around using the tool with three identified young people, with the completed assessment being presented in each case with evaluation of its reliability. The questions that will be asked in this report are;

  • Is the tool in its present form acceptable for real-time use, in classroom or home settings? (Usability)
  • Do the findings in each case correspond between both assessors? (Reliability)
  • Are the assessors able to formulate a plan for development and learning based on the findings of the assessment? (Robust)
  • How might the tool be adapted to make an electronic version? Would this enhance the process? (Marketability; accessibility)

3. Scheduling/Phasing

3.1. Overall Scheduling

It would be ideal if the test phase of the draft tool could take place in the first term of the 2011/12 school year. This would enable three months of activity around using the paperwork and completing journals with the report to be completed by March 2012. This would provide evidence and information for the next phase of the project and allow time to look at the cost and viability of this.

3.2.ProjectSchedule

Please see full project schedule inAppendix X

4. Resourcing

4.1. Price and Funding Source

Year / Staff / Non staff / Total Price
2011/12 / nil / £ 3,600
Project Total / £3,600

Existing staff budget for Teaching staff and Children's Home Team Lead will cover costs in this respect; no backfill is anticipated.

Equipment is not included in the funding requirement as this has already been achieved through a generous donation from Boots Opticians.

Other non-staff costs relate to consultancy associated with the validation of the assessment tool and advice around its use, training of assessors etc. The consultants are experts in the field of visual impairment and complex needs and have been involved in this project from the outset. Lucy Naish is a qualified teacher and specialist in sensory disability who currently trains teaching assistants through the Partners in Learning Programme at Pears Centre. Judy Bell is a senior teacher of the Visually Impaired and a consultant in sight loss and visual impairment, having previously been employed by RNIB in Children's Services. Judy has a long association with RNIB Pears Centre[7].

The time cost identified is anticipated to be four days overall for each of two consultants, plus expenses.

Source(s) of funding:

Work so far on this project has been funded through savings in the Healthcare and Therapies budget. Most of the working group membership gives their time for free, so minimal costs have been incurred, save for the input of consultants Lucy Naish and Judy Bell.

As there is no longer any capacity in the Healthcare and Therapies budget, further money needs to be found to continue to fund the input of these consultants. As donations from Boots Opticians have already been made to provide equipment for testing, it might be possible to divert some of these monies to support this phase of the project.