Vision and Blindness

If you wear reading glasses, please remove them for a moment, and continue reading.

Back to normal? For a moment, you had an experience like that of about 30% of Baltimore students. Some have myopia (nearsightedness) and some hyperopia (farsightedness), and some other problems. But few have glasses. A study in grades 2-3 found that only 6% of students had glasses in school, and 30% needed them. Kids being kids, even those who have glasses may soon lose or break them, and glasses are rarely replaced for kids in inner-city schools. As a result, some students can’t see the whiteboard, some can’t see their books, and many quietly think they are not smart because they struggle to focus on the printed word. In Maryland, students’ vision is tested only at school entry (usually pre-k), first grade, and eighth grade. If routine screenings find a problem, a note goes to parents asking them to get a formal assessment. In Baltimore, this results in about 10% of children who need glasses getting them. And then what do you think happens to those glasses between first and eighth grade?

I’ve been involved with studies of vision in inner-city schools along with colleagues Megan Collins, David Friedman, Michael Repka, and others from the Wilmer Eye Clinic at Johns Hopkins Medical Institutions, and Nancy Madden and others from the Johns Hopkins School of Education. The name of the project is Vision for Baltimore, and it operates under the authority of the Baltimore City Health Department, which has been a strong supporter. What we are finding is in one sense a privileged glimpse into the perfectly obvious. Inner city children who need glasses don’t often get them. We tested all students in grades 2-3 in 12 high-poverty Baltimore schools, and we gave those who needed them free glasses. We also followed up to make sure the students were wearing glasses, and we replaced those that were lost or broken. Students who received the glasses gained significantly on reading tests in comparison to those who never needed glasses. Of course. Yet this was the first U.S. study of its kind to show an effect of glasses on reading (two Chinese studies had found the same).

We are now doing a much larger study. A philanthropic group called Vision to Learn (VTL) wanted to provide assessments and free glasses to every elementary and middle school student in Baltimore over a three-year period. VTL has mobile vision vans, staffed with an optometrist and an optician. The vans can test all students who were found in screening to need assessment, and then provide free glasses if needed. With funding from Baltimore’s Abell Foundation and the Laura and John Arnold Foundation, we arranged to randomly assign schools to receive their vision services either in the first, second, or third year, enabling us to find the impact of these services in reading and math performance, mostly on state tests.

It will be a couple of years before we will know the results of our research, but I can tell you this much. As in our smaller study, we found that very few children already had glasses, and about 30% needed them. This fall, the first glasses are arriving, and the students are blown away. One fifth grade girl said, “Is this the way things are supposed to look?”

Now think about that girl. If she needs glasses now, she has probably needed them for years. How much damage was done to her essential early education? How much was her self-esteem damaged by learning problems due to nothing more than poor vision?

I should hasten to add that eyeglasses for students who need them are an inexpensive intervention. In the enormous quantities involved, a pair of glasses that kids are eager to wear may cost less than $20. Further, Medicaid pays for eyeglasses for all children who qualify as low income, which equates to nearly every child in Baltimore. Vision to Learn has worked out ways to make this easy to administer, so that modest funds from an existing federal program can be used for this essential service.

Vision is important. We hope our work and that of others around the U.S. will develop simple, replicable means of improving the achievement of disadvantaged children by giving them needed eyeglasses. But what I really want to talk about today is not vision, but blindness. Moral blindness. Policy blindness. Pragmatic blindness.

It so happens that vision is an excellent case to illustrate our moral, policy, and pragmatic blindness. We spend approximately $11,000 per child per year, on average, to educate a child. From all that expenditure, we want successful, capable, skilled students, who can enter higher education or the workforce with confidence and well-founded hopes of success. We want students who will follow the rules because they know that they can succeed if they do.

Yet we let $20 worth of eyeglasses stand in their way.

We spend vast amounts of money on special education, remedial services, even tutoring. Yet some proportion of the children who receive these services just needed eyeglasses instead. The policy world has tried for years to reduce special education costs and integrate children in regular classes. Many likely never needed special education to begin with.

Yet we let $20 worth of eyeglasses per child stand in our way.

We know that young people who fail in school are far more likely to become delinquent and later criminal. The costs of policing and incarceration are huge, and we need to reduce them.

Yet we let $20 worth of eyeglasses per child stand in our way.

There are lots of very difficult problems in education. This does not happen to be one of them. Can we all agree to put glasses on every disadvantaged child who needs them? This will not solve all of our problems, but if would be a heck of a start. While we’re at it, we also ought to look into hearing and other medical problems that hold kids back.

There are none so blind as those who will not see.

Correction

In an earlier version of this blog, I forgot to mention the name of the project and the authority under which is operates. I apologize for the omission.

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Education Policy In The Age Of Proven School And Classroom Approaches

Education policy is informed by politics, personalities, myths, and money, far more than it is by evidence. There is good research on policy, but because so many individual policies are in play at any given moment, it is very difficult for policy researchers or policy makers to figure out the effects of anything. Policy makers often follow a pendulum pattern, declaring current policies a failure and recommending that school leaders do the opposite. Several years later, they may swing back in the original direction, perhaps under a new name. Policy makers are intelligent and caring people, and they do their best. But it is difficult to take into account all the conflicting interests, experiences, and advice they must juggle.

One potential consequence of evidence-based reform at the school and classroom levels might be to make the larger education policy realm a lot more rational and impactful. The idea is that if policy makers were clear (from rigorous research) what classrooms should look like, they could design policies single-mindedly directed toward facilitating the use of those classroom strategies.

In a blog some time ago, I gave one parallel to this: the tuberculosis sanitarium. Up to the mid-20th century, people with tuberculosis were sent to sanitaria where the disease was managed by a caring staff, but there was no cure. Policies were probably very diverse about qualifications to work in sanitaria, facilities, size, connections to other medical services, and so on. But it is doubtful that any of these policies mattered very much, because they did not cure the disease.

When tuberculosis was cured with drug treatment, all those complex policies fell away and were replaced by well-organized policies to diagnose and treat the disease. The sanitaria closed, and the whole elaborate policy structure behind them disappeared.

In education, widespread adoption of proven approaches could have a similar impact. If we have specific, replicable, and highly effective strategies for teaching reading, math, science, social studies, and writing, for example, we’d need to select and train principals to ensure that these effective methods are properly implemented and producing the outcomes they should be producing. We’d structure school boards and superintendents to support principals in leading schools capable of implementing proven programs. At the federal and state levels, policy would come to support constant advances in the quality of proven programs and in their evaluation and implementation. Funding for states, districts, and schools would be aligned with cost-effectively supporting what works.

Policy and leadership are crucial no matter how definitive the evidence for particular classroom practices. But leadership is a lot more effective when leaders know what teacher behaviors their leadership is intended to establish and maintain. Helping all staff to understand and implement proven programs should become the goal of every educational leader. When we have proven and replicable school and classroom strategies, policies from the White House to the school house can be aligned around the requirements of effective classroom practices.

Spend Smart to Achieve Equity in Education

Politics, it is said, is all about who gets what. “What” is defined as money. Good people of all parties generally want to use government funding to improve peoples’ lives. But is giving people more money the same as improving their lives?

In education, money is important. Improving education usually costs money. You can’t make chicken soup out of chicken feathers, as we say in Baltimore. Further, inequalities in education funding between wealthy and disadvantaged districts within the same regions remain substantial. The children who need the most get the least, because education funding is usually tied to property taxes. Obviously, areas high in wealth can raise a lot more money with the same tax rate than can neighboring districts low in wealth. This is understood by all Americans as just the way of the world, but it is in fact anything but the way of the world. In fact, our system is so unfair and so unlike what happens in our peer nations that when I talk about it abroad, I have to explain it three or four times before my foreign friends can understand how any advanced country could do such a thing. In all other countries I know about, all schools receive equal funding, most often supplemented to help impoverished schools catch up. This has been true for decades, under right wing and left wing governments throughout the developed world.

I believe that equalizing school funding, and supplementing it for disadvantaged schools, is a moral responsibility, well worth fighting for. But will it solve the inequities in outcomes we see among our schools serving wealthy and disadvantaged neighborhoods?

This is a more complex question. But the simple answer is that for improving outcomes, there are better and worse ways to use money. We know a lot of proven strategies for turning money into achievement, and with modest continuing investment in the resources to help schools adopt and implement proven programs and in national R & D to create and evaluate proven programs, we could make substantial progress in reducing gaps and gaining on our international competitors. But if we expect that simply adding money to the current system will be sufficient, we are likely to be disappointed.

Spending is always a contentious issue. Spending smart should not be. Whatever we have decided to spend on education, we can all agree that every penny should count and the best way to ensure that money makes a difference is to use it on proven approaches.

Equalizing or even supplementing funding for high-poverty schools is the right thing to do, but we cannot just spend. We have to spend smart.