Published June 16, 2025

By Sylvia Trujillo, MPP, JD and Miguel Angel Del Villar, BSN, RN, CSN

In part one of this series we talked about why early detection of vision issues is so important, especially for children with developmental disabilities, how telehealth screenings work in schools, and why compliance with state guidelines matters for schools in California. Keep reading to learn more about the evidence-based benefits of early screenings for vision, how to continue to monitor vision, and some critical resources to help inform your organization!

Evidence-Based Benefits

Research consistently demonstrates the value of early screening interventions. Individual randomized, longitudinal studies have reported that early screening is associated with a decrease in the prevalence of amblyopia and improved acuity by up to 70%. Furthermore, intervention before kindergarten has huge academic, social, and economic benefits, with studies showing children who receive early treatment for developmental delays are more likely to graduate from high school, hold jobs, and live independently.

Combined hearing and vision screening programs offer reported benefits including earlier detection of vision and hearing difficulties to support functioning and quality of life as well as resource sharing for reduced costs. However, available research shows that children frequently experience difficulty accessing follow-up after referral from a vision screening, with over half of children who meet referral criteria during screenings not receiving follow-up services.

Ongoing Monitoring and Adherence

• For students with special needs, this ongoing monitoring is particularly valuable.
• Many children who are disabled have problems with seeing due to damage in pathways leading to the visual cortex, while other disabled children have difficulties interpreting visual information as a result of damage to pathways leading from the visual cortex to higher centers, requiring specialized follow-up care.
• Beyond initial screenings, telehealth also supports adherence to care plans.
• Providers can check whether students have followed through on referrals or recommendations, conduct remote follow-ups, and collaborate with school teams to ensure continuity of care.
• These virtual touchpoints add visibility and accountability, both of which are often difficult to sustain in traditional models.

Meeting Broader Needs

While current priorities highlight vision and hearing screenings as the most pressing needs, telehealth is also being implemented across schools for IEP services, mental health support, and supplemental nursing coverage. Each application aims to increase access, reduce delays, and ensure students receive timely support.

Many children with developmental delays or behavior concerns are not identified as early as possible, causing these children to wait to get the help they need to do well in social and educational settings. Telehealth screenings help bridge this gap by making services more accessible and reducing barriers to care.

Looking Ahead

Telehealth is not a replacement for traditional care—it’s a practical extension that helps schools deliver essential health services when onsite resources are limited. With the right tools, providers, and partnerships, telehealth ensures students receive timely, compliant, and high-quality care without disruption to their learning environment.

Key Resources for Implementation:

As California continues to innovate in educational health services, telehealth screenings represent a meaningful step toward ensuring no student’s health needs go unaddressed, particularly those students who are most vulnerable and in greatest need of early intervention support.

To learn more or request technical assistance, visit www.caltrc.org or reach out to our team directly.

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*Sylvia Trujillo, JD, MPP, is the Executive Director for the California Telehealth Resource Center where she has a leadership role in driving access to quality health care leveraging digital innovation. Sylvia is a national expert on federal and California policies related to virtual care, health IT, and new health care payment and delivery models. Under her leadership, CTRC has expanded community-based and national partnerships with a focus on equity and sustainability.

**Miguel A. Del Villar is a credentialed school nurse and CEO of a California-based organization dedicated to expanding school-based healthcare through innovative service models. With a background in nursing, school health, and telehealth implementation, Miguel supports districts in addressing staffing shortages and improving access to care.

Citations and Optional Resources

📚 Citations

California Department of Education. (2019). A guide for vision screening in California public schools.
https://www.cde.ca.gov/ls/he/hn/documents/visionreport.pdf

Includes references to California Education Code requirements for school-based vision screenings.

California Department of Health Services. (2000). Manual for the school audiometrist: Audiometry guidelines, hearing conservation program. Children’s Medical Services Branch, Hearing Conservation Program.
https://www.dhcs.ca.gov/services/hcp/Documents/audmanschool.pdf

Outlines procedures and mandates for hearing screenings as required by California Code of Regulations, Title 17.

California Education Code § 49455(a)(1). (n.d.). Vision appraisal requirements for public school students.
https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=49455&lawCode=EDC

California Code of Regulations, Title 17, § 2952(c)(1). (n.d.). Hearing screening requirements for public school students.
https://www.law.cornell.edu/regulations/california/17-CCR-2952

🔍 Optional Resources (for context or extended reference)

Executive Summary: Telehealth Evolution in California (January 2025)
California Health Care Foundation

See page 3, third paragraph under “Telehealth Implementation” for insights into school-based telehealth integration.
https://www.chcf.org/wp-content/uploads/2025/01/THEvolutionCAES2025.pdf

Findings from the 2022 National Census of School-Based Health Centers (September 2023)
School-Based Health Alliance

In 2022, 90% of SBHCs provided services via telehealth—up from 19% in 2016–17.
https://sbh4all.org/wp-content/uploads/2023/10/FINDINGS-FROM-THE-2022-NATIONAL-CENSUS-OF-SCHOOL-BASED-HEALTH-CENTERS-09.20.23.pdf

The Critical Role of School Nurses Amid Staffing Shortages (2023)
CBS News

Students seen by unlicensed staff were sent home 18% of the time vs. 5% for those assessed by school nurses.
https://www.cbsnews.com/news/school-nurses-staffing-shortage-problem

Issue Brief: Tele Mental Health in California Schools (January 2023)
National Health Law Program

Telehealth visits for outpatient mental health and substance use services in California surged from 0% in 2019 to 40% in 2020, stabilizing at 36% in 2021—highlighting the rapid expansion of school-based tele-mental health services.
https://healthlaw.org/wp-content/uploads/2023/02/Issue-Brief-Tele-MH-in-CA-Schools_2023.pdf