Essential Tools for California Schools Telehealth Vision and Hearing Screenings: Part 1

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

 The Critical Importance of Early Detection

Consider Maria, a second-grader with autism spectrum disorder who struggles to communicate when vision problems make it difficult to see the classroom board. Without proper vision screening, her learning challenges may be incorrectly attributed solely to her developmental disability, delaying crucial interventions.

Or take James, a student with cerebral palsy who experiences hearing difficulties that go undetected because a physical disabling condition overshadows routine hearing assessments.

These scenarios highlight why comprehensive vision and hearing screenings are particularly critical in school settings, especially for students with special needs.

According to the CDC, approximately 6.8% of children have a vision condition and about 8.5% of children aged 3-17 have a developmental disability such as autism, a learning disorder, or attention-deficit/hyperactivity disorder. When these conditions intersect, early identification becomes even more crucial for supporting academic success and overall development.

Across California, schools are finding new ways to ensure students receive essential health services, even when resources are limited. Telehealth has emerged as a reliable method for delivering vision and hearing screenings in educational settings, offering a practical solution where onsite staffing is limited or unavailable. Rather than replacing traditional care, this approach bridges the gap between mandates and meaningful access.

How Telehealth Screenings Work in Schools

• School staff, clinical or non-clinical, can help initiate a telehealth connection between a student and a credentialed health professional.
• The licensed provider remotely reviews and controls screening software and equipment, such as an audiometer or digital visual acuity optotype, in real time.
• This allows screenings to be completed at the required distances and frequencies while ensuring a smooth, student-friendly experience.
• A preferred implementation model includes headphones for hearing screenings, where students press a button when they hear a tone.
• For vision screenings, students read letters aloud from a digital screen at varying distances.
• These familiar, interactive methods keep students engaged and comfortable while ensuring clinical standards are met.

Special Considerations for Students with Disabilities

Telehealth screenings offer particular advantages for students with special needs. Students with neurodevelopmental disorders, including cerebral palsy, hearing impairment, Down syndrome, cognitive impairment, autism spectrum disorders, or speech delay, have a higher rate of vision problems than those without neurodevelopmental abnormalities. The remote nature of telehealth allows for:

• Familiar school environments that reduce anxiety for students with autism or sensory processing disorders
• Flexible scheduling that accommodates IEP requirements and therapy sessions
• Real-time consultation with specialists who understand disability-specific screening modifications
• Immediate documentation that integrates with special education planning

Compliance Still Matters

While telehealth introduces new flexibility, schools must still follow state guidelines.

• California requires vision screening on all students upon school entry and every third year thereafter through grade eight, with vision testing typically done in kindergarten or first grade and in grades two, five, and eight.
• Additionally, hearing screening is mandated in kindergarten/first grade and in second, fifth, eighth, tenth/eleventh grade and upon first school entry, and must be conducted by a credentialed school audiometrist.
• Using telehealth does not waive these requirements.
• Providers conducting screenings must be appropriately credentialed, and equipment must meet state specifications.
• If contracting services for IEP-related telehealth screenings, be sure the provider is a certified Nonpublic Agency (NPA).

California requires that all vision and hearing screenings adhere to standards outlined in:

• A Guide for Vision Screening in California Public Schools – California Department of Education
• Manual for the School Audiometrist (Audiometry Guidelines, Hearing Conservation Program) – California Department of Health Services, Children’s Medical Services Branch

Stay tuned for part 2 of this blog series which will look at evidence-based benefits, ongoing monitoring, and more resources!

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

*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.