TRANSCIPT
Standardized Infant Functional Vision Screening Using NAVEG
10/6/25 

>>Hillary: I'm Hillary Keys, I'm the early Deafblind consultant on the Texas Deafblind Project. Thumbs up if you guys are all seeing the Standardized Infant Functional Vision Screening Using Neonatal Assessment Visual European Grid or NAVEG. We're excited to be here today. Diane. 

>>Diane: Yes. I am very excited to be here today. This is something that is near and dear to my heart. I really feel strongly about it. I am so happy to see so many people joining in to learn more about this new screening instrument. And Hillary and I are really thrilled to be able to share it with you. 

>>Hillary: Absolutely. Here are our e-mails. You will see those again at the end. So and I'm sure we'll be happy to share them in the chat if anybody needs our e-mail addresses. So our objectives today are to explain the rationale for using the NAVEG. Why we want to use it. Identify conditions associated with CVI, or Cortical Visual Impairment. Become familiar with the screening materials. Have an understanding of the screening components of the NAVEG and learn about training options. Because this is just going to scratch the surface today. So our agenda today, we're going to cover the conditions associated with CVI first. Then NAVEG the rationale, components, and a little bit about your options for NAVEG training. 

>>Diane: Let's just talk real quickly about the conditions associated with Cortical Visual Impairment. I want to make sure that everybody here understands that this CVI, Cortical Visual Impairment, has to do with the brain. It is not a problem with the eyeballs, it is a problem with the processing of the information that the eyeballs is sending back to the brain. When there is damage in the brain, it affects how we visually function in the world. Remember, there's a great key thing that I'd like you to remember about this. Vision alone engages one-third to one-half of our cerebral cortex, making sight the most neurologically demanding sense that we have. So there's a great deal of the brain that processes visual information. There's lots of little things that can go wrong in the brain neurologically and that's when we start seeing symptoms and signs of Cortical Visual Impairment. So some of these conditions I want you to remember that this is not an exhaustive list of conditions. But these are conditions that are red flags that you really need to know about. Children that are born prematurely are often at risk for Cortical Visual Impairment. Those next two acronyms, PVL, HIE, you really need to know what they stand for and what they mean. Because oftentimes doctors will write them in the medical reports or people will throw those acronyms around and you need to know that they're associated with Cortical Visual Impairment in a big way. And periventricular leukomalacia, hypoxic ischemic encephalopathy. Those have to do with neurological damage and they are very common in our children with Cortical Visual Impairment. Focal damage to the brain chromosomal or genetic disorders. We're seeing more and more children who have genetic disorders, very unusual genetic disorders that are demonstrating Cortical Visual Impairment as well. So keep that in mind. Metabolic disorders, meningitis and encephalitis and cerebral palsy. Think of all the students with cerebral palsy. Do they even have a diagnosis of Cortical Visual Impairment? That's very common in our students, cerebral palsy. 

>>Hillary: So babies count is the only can national database that collects information about infants and toddlers who are blind, visually impaired, and between the ages of birth and 36 months. It's managed by the American Printing House for the Blind or APH and Texas does not participate in it. A lot of the larger states don't because it's very involved and they get a lot of interesting data. So the most recent -- last time I checked, the most recent data was from '22, '23 that 32% of babies with visual impairment have a diagnosis of CVI. That's a huge number of kiddos. That age of diagnosis is about 14.5 months. Think about how fast the brain grows for little ones and we're about halfway through that -- not quite halfway through that period of exponential growth when they get a diagnosis. And then the age of referral to services for a child with CVI is typically around 12.4 months. And then another month before they're enrolled for services. And that, again, is from 2023. Of those babies who have CVI, you know, that is a lot. We know that we see them coming in at 3 years old a lot of the times to the schools, so we want to catch them early. 

>>Diane: Yeah. Another point about that slide I'd like to add, Hillary, if I can, about your last slide. That age of diagnosis of CVI, 14.5 months. That's not what I'm seeing so much. That sounds very, very fantastic, if it's 14.5 months. Usually it's more like 3 years of age when they get identified. But I also want to point out to you that remember that the peak periods when neuroplasticity and the plasticity of the brain is at its greatest is birth to 2.5 years. If we're not catching these kids until 14.5 months, which I think is optimistic, we're already behind. We need to be catching them earlier. We need to be screening and we need to be making sure that they get a diagnosis earlier. This chart, it's hard to see because it's a little bit tiny. And if anybody would like a link to it, maybe we could have it as a handout or something. I have it posted here because I think that it is so relevant, this chart. I want you to take a look at that down along that lower line where it says "birth." And where visual -- there you go. Thank you so much. Where visual starts happening. Even before birth. So this graph shows how synapse or connections in the brain develop over time and when they are most critical. You can see that the visual connections begin before birth and actually start to decrease by 6 months. This means vision is not only present but this early time period is critical for visual development. So if all of this critical work is happening with regard to vision in those first six months and we're not catching kids until 14.5 months -- again, which I think is really would be great if that was happening. That's not what I'm seeing. You know, we're already behind. We need to catch them earlier. So this is a fantastic chart right here. And I hope you'll think of it when you think about learning how to use this screening tool and putting it out there with the people that you know. There's some really great points on this slide and I'm going to quickly go through them. They're just super important points to make. Babies are capable of using vision even at 37 weeks gestation. Understanding this really can change the standard of care. That early brain plasticity, which can rewire visual pathways, that's what we need to be focusing on for these little tiny babies that really could get better using their functional vision, if we can get to them early enough. With early parent and team training, we expect to see improvement in the use of their functional vision. And we do. We do see improvement. I'll be talking about that in just a little bit. And, you know, I just think about all the families that I've worked with. Getting this information out to them empowers them. It really makes them feel good about what they're doing. It is less of a hopeless feeling for those families. So why does this matter to us? Listen, the key takeaway that I really want you to be thinking about is when children are identified early is at neurological risk for CVI and provided with early intervention services, services from a TVI, from orientation and mobility and speech, et cetera. The outcome for functional vision use is much, much, much more positive. Where Hillary and I got our training and others at the Outreach at TSBVI, we got our training from the anchorage center out in Colorado. And this group got a hold early of the NAVEG screening and they just went to town on it and really developed a fantastic program around the NAVEG. Now, they currently provide services and they are keeping close track of the gains that they are making. The Anchor Center's recent data indicates that of their 141 students who have a CVI diagnosis and have been assessed using the CVI Range more than once. Over 98% of them have demonstrated improvement after receiving services. I mean, that's really, really remarkable and they're gathering more and more data as we speak. For those of you who don't know, the CVI Range measures functional vision, especially as it relates to visual attention. And I hope everybody is aware of what the CVI Range is. But the earlier that diagnosis and the referral is made, the better the outcome. That's for sure. 

>>Hillary: This is Hillary. I just want to add in that the way that Anchor Center has gathered a lot of this data is they have partnered with hospitals and neonatal units in their area and they are doing data gathering and it's very scientifically based. I think these are very reliable numbers. And so why do we use the NAVEG? Well, I think Diane is making the point that we absolutely want to identify these infants as early as possible. From brain development standpoint, the more that we can get done in those earlier years, the more integrated, not just vision, but the whole system will be and that will provide better outcomes. As Diane said, so much of our brain is occupied by using vision that if we can improve that early on then that's going to make a huge difference in the entire life of the child. So the NAVEG has several benefits. Early identification and this allows us to make those interventions that we need to do. The fact that we have better training and better brain imaging research now means that we have a greater understanding of visual development in general. And in the next few years we think that visual development charts will change and show that babies are capable of skills earlier than we even realized. There's research going on about vision inside the womb. So we know that babies can perceive -- they actually are born perceiving faces and preferring faces because they can tell faces in the womb. Interesting little study. So CVI is on the rise. 32%. And that's old data so I'm sure it's probably higher now. And the National Institutes of Health is called CVI, a public health crisis. So the brain has the early neuroplasticity that we want to get in there and make changes and make the environment accessible for these children as early as possible. And standardized vision screenings, this standardized vision screening shows neurological risk and has components that covers all areas of early visual screening. Unlike things like retinopathy prematurity or ROP, this screening is not invasive. We barely need to touch the infant and in some cases we do not need to interact -- potentially do not have to interact with the baby directly. And it's proved to be really relatively easy. People who are not medical professionals or vision professionals can be trained to do this screening. So that makes it easy to learn and to use and to train others. Are there any questions so far? Okay. So this is not an assessment. If you're thinking about the CVI Range that Diane mentioned, this is not that. This is a very, very simple, quick, broad assessment that's usually very brief. And it's used to identify whether an individual demonstrates characteristics of the specific condition of CVI. It does not provide a diagnosis. It does use a few -- only a few very specific tools and, again, it can be conducted by anyone as long as you've had the training. It's a great way to catch these kiddos. And so without further ado, we'll jump into the components of the NAVEG. 

>>Diane: Okay. I'm just going to add on to what Hillary said. I want to stress to you that this is a very simple group of materials. Those of you who have watched me go in and do a Functional Vision Evaluation using the CVI Range, and I drag in my gigantic black Samsonite suitcase filled with materials and I have bags and baskets with everything else. And then writing the report that is 10 to 20 to 24 pages long, this isn't that. This isn't that, y'all. Okay. Take a look on your left side of your screen. It's a one-page score sheet. And it's broken down into three main components that are looked at. And then there's subareas under each component. And I'm going to go into a little bit more detail, but not much. But it's just that single sheet. That's all you fill out for this screening. On the right side of your screen -- oh, let me just point out that for those scores, your choices are either giving a zero, which means that the child had a healthy response, a normal response. A 1, which is an incomplete response. Or a 2, an atypical response. Now, let me just tell you. Think about that. It's a 0, 1, or 2. And a 2 means an atypical response. I'm going to say this a couple of times because I want to clarify and be clear that this is a quick, easy screening once you learn how to do it. You only have to get a total of 6 points. And then, really, you can stop. And that, at a score of 6 means that that child is at risk for Cortical Visual Impairment. And then you refer them to get a full check out by an ophthalmologist. So you only need a score of 6 or higher, if you wanted. But babies are hard to test and it's hard to keep their attention. So you want to do the easiest subareas first. Keep that in mind. I'll go into that more in a minute. Look on the right side of your screen. That's all the bits and pieces you need. Those are all the components that you need for this screening. Many of you are familiar with them. You've got the LEA paddles. You've got the hiding Heidi that's in there. You've got some white balls, red balls, and yellow balls with Xs on them. It's not much money to put this kit together either. You have an iPad or iPhone app that's an kinetic drum. A pen light, which I'm sure that we all have somewhere in the cabinets. Now, this is one thing that you most likely don't have and you learn how to use it during the training. It's an opthalmascope. I don't know about you but I have been working in the field of visual impairment since 1979, 1980. A long time. And I've never, until working on this screening, learned how to use an opthalmoscope. But you'll get some good training how to use this. That's the only slightly tricky thing. Of all the other things, you guys know how to use pretty well. Keep that in mind. There's not that many pieces. In the photo there, there's a picture of that one-page scoring sheet. Just one page. You're just filling that out and that's it. And then there's sort of a cheat sheet that comes with it that helps to break down how to score it. So you're only filling out that one-page sheet. This does not take long. This is not like the Functional Vision Evaluation. I think that people get worried when they hear about another device that's out there to use that is going to take a lot of time. This does not take a lot of time. So please do keep that in mind. Let's see if I forgot anything here. So we can go on to the next slide, Hillary. 

>>Kaycee: This is Kaycee. We've had some really great questions in the chat, if you don't mind me interrupting and sharing those. Is that okay? 

>>Diane: Yeah, that's great. Thank you so much, Kaycee. 

>>Kaycee: Sure. We had one come in asking if this needs to be done in a separate individual space or if it can be done as a booth, like a station, in a child find outreach situation and you have families coming in? Is it something you could do at a booth to screen or does it need to be like a one or one individual, a quiet space situation? 

>>Diane: That's a really, really great question and Hillary might have some additional comments in case I forget something or don't state it exactly correctly. Throughout the training, when Anchor Center was training us, I kept thinking, oh, you know, why aren't they wearing black? Why aren't they making sure that the background behind what they're showing this child in the videos that they were showing us, that they've got so much clutter back there? You know, as I would think, of course. But that's not the case. You're trying to take a look at this young child, this young infant in a typical situation. You can wear whatever clothes you want. You're not trying to modify the environment to see what's the best use of their vision that they can possibly be given us. We're trying to see if there's a problem here. So to answer whoever's question that was, you could do it in a Child Find in a little booth off to the side. You're trying to see, in a typical situation, how this child uses vision. If the child can't use vision like any other neurotypical child would in this setting, then you're going to get some scores of 1 and 2 on there really quickly. To answer your question, you can do it in a typical setting. Hillary, do you have something to add to that? 

>>Hillary: This is Hillary. From an early childhood standpoint, just a few thoughts. Whatever the situation is, if it's a big outreach fair and there are a lot of people and things going on, you might want a quieter spot and you might think about what is the bio-behavioral state of the child when you do the screening. If they're tired or whatever's going on. 

>>Diane: Hungry. 

>>Hillary: Hungry. If they're not really cooperative, you might want to schedule a time for them to try again, just to make sure. Some things like that. But, yeah, I think that it would be wonderful if we could just have these screenings going on all the time. I wish it would be in every neonatal unit. 

>>Kaycee: That leads me to another question. Someone asked if there is a movement to get pediatricians trained, especially those who work in the NICU. 

>>Hillary: That is something that we are trying to make some inroads on. We have Dell -- we kind of have an in at Dell Medical Center, so we're trying. We're also looking at working with some ECI, Early Childhood Intervention Programs in the state. But, yes, medical would be wonderful to get more medical professionals. We just started this journey so we need to get the word out. 

>>Kaycee: Perfect. And all the others have answered or I can tell will soon be answered so I think we're good to move on. 

>>Diane: I'll talk about that ophthalmoscope here. When you come to the training, we will have collections of these materials for you to use. But to answer, Shannon, your question. Yes, you can get one off of Amazon. We have some other links that you can take a look at. We have some places for you to go. I think that there's only two that you kind of have to really get from a special area. It's that Good Light where you order the LEA paddles and the Hiding Heidi -- usually they're ordered from Good Light. There's a couple other places but those are the items that are a little bit more expensive is the LEA Grating Paddles and the contrast sensitivity, the hiding Heidi. We'll talk more about that when you attend the training. And also we'll have a few different types of ophthalmoscopes there so you can see if there's one you prefer better. Probably -- I got a very cheap one from Amazon. I'll be curious to compare it to a little bit more expensive one that is also in the TSBVI collection. So that will be covered during the training. 

>>Hillary: Ready? 

>>Diane: Yep. 

>>Hillary: I'll start us off talking a little bit about the organization of the screening. It's grouped by categories. There are three categories. Ocular visual has four components. Motor visual has nine components. And the perceptual section has four components. So as you go through this, there are obviously more than six components. But you only need a score of 6 to say we need to refer this child to an eye medical professional. 6. You're looking for a 6 or below. Below is good. 6 you want to go ahead and refer. So if you hit 6, if you get 6 points before you finish the screening, you're done. The screening is done. Now, there are also -- very important -- there are observational and interactive components. It is better to do the observational components first. Some of these things have to do with looking at records or just getting information without interacting with or possibly causing an aversive reaction in the child. It's better to do those first and you could possibly get a 6 just by doing the observational components. So it's much easier on the child. And, again, it's really quick. The grouping -- each grouping contains both observational and interactive screening components except one. Diane will cover that in a minute. And when conducting the screening, you go through all the observational and active components. And, yes, I'm repeating because we all learn by repetition and that's something we really wanted to get across to you that it is easier on the child to do the observations first. Some components do include a bright light, and that should be done at the very end of the screening because it can be very aversive to the child. It can contradict the pupils. You can get the after glow that you're seeing. And it's just best practice to wait. If you need to do that at all, you would do it at the end of the screening. If you do it at the beginning too, it could skew your outcomes. And for ocular visual, the observational components are eye abnormalities. You can just look at the eye and see, like coloboma in the picture we have on the screen. It's an iris coloboma, so that's visually available to you. And fundus abnormalities. That's information from the eye report because we didn't have a fundus machine. Those are not something we typically use. This is not from the ophthalmoscope. It's from records and reports from the NICU and ophthalmologist and potentially a medical doctor, but it is something you can get information about. 

>>Diane: This is Diane. I'll just quickly answer Diana's question real quickly. She's asking what is the age range this tool can be used on. It is primarily meant for preschool. Kids from birth until 12 months of age, maybe even up to 2.5 years of age. But there was also some comment, Hillary -- and maybe you can remember it -- or I think Lynne is on here. That even kids that are developmentally functioning at a very young age or have developmental delays, it could be used on them. And then you just note that it is primarily used on younger children. But the screening device was used. Hillary, what do you remember exactly about the age? 

>>Hillary: The study that was done in Italy validated this tool for children from birth to 12 months. So that is the official validation. The medical validation. But then the Anchor Center has been doing it on some older children but I don't remember the exact threshold. Yes, it can be used on older children, it's just that the validation, if you're looking at it from a scientific basis, just goes to 12 months. 

>>Diane: Thank you very much for adding that. Lynne has added also validated for medical research up to 12 months of age and functionally can be used to age 10 or so, as well. So do keep that in mind. So I just want to get back to where we were talking. There are three main areas on our score sheet. The ocular visual component, the motor visual component, and the perceptual visual component. And then there's sub areas underneath each one of those components. And we're just looking at the observational parts of those three components now. So Hillary just went over the observational parts of the ocular visual component. Now, I'm going to be talking about the observational parts of the motor visual component. And those are: Sunsetting, nystagmus, paroxysmal deviation, strabismus, and erratic eye movements. Now, there's a couple here. Sunsetting and paroxysmal deviation that I didn't use regularly as a TVI or even with kids with CVI. But you learn about what those things are. I'm just going to quickly just tell you just a little bit about what they are but you're going to learn more about them in the training. Sunsetting is when the eyes lie very low. This is usually seen in young children that have hydrocephalus. And sometimes the pupil is even below the lid. Nystagmus, I think we're all familiar with that. Involuntary eye movements. Paroxysmal deviation, it's most often associated with genetic disorders. The eyes appear to be stuck in an upward gaze. As I'm saying this you guys might have seen some kiddos that have difficulties along these lines. So be thinking about that. It's usually upwards and towards the right that they get stuck. And usually the child's eyes get stuck in that same place again and again. It's usually not random and in different places all over. Strabismus, we are very familiar with strabismus and it is very frequently a condition associated with Cortical Visual Impairment. One or both eyes are misaligned. They are either turning inward or outward or upward, downward. And erratic eye movements are just what it sounds like. There is one condition called -- and I might ruin this, Hillary, if you can help me with it. Opsakalonis. It's unusual eye movements like a tic. You'll learn more about that in our training, if you come to it. Go on. There is observational components in the ocular visual section of this screening as well. And these are the two that Hillary mentioned earlier that you want to reserve for the very end of the screening, if you have to get to that. If you have already got a score of 6 already, I would leave them out because kids turn away, they do not like this. Pupillary light reflex. And what you're doing is you're watching to see if the pupil constricts when a light is shining towards their eyes. Guess what. I don't like it when the doctor does it to me. And little babies really don't like it. So you really want to leave that one last. Also, the red reflex. You're looking for that red reflex. You're often familiar with it. It used to be shown in photos when you would take photos of people. There would be that red eye in the center. And you'll learn how to look for that during the training. Hillary. Okay. This is -- I want to talk now about your interactive parts within this screening. So now we're going to go back up to the -- this is in the motor visual section. And it's your interactive things that you need to do. I failed to mention that on the last slide. Those were interactive as well. The interactive parts of ocular visual were pupillary light reflex and red reflex. Sorry. I should have mentioned that. This continues our interactive parts of the screening in motor visual. And it is to look for fixation, horizontal and vertical pursuit, and saccadic movements. You're looking to see if the child can demonstrate evidence of fixation. You know, I thought of this one when one of our people in the chat was saying can you do this anywhere. Maybe in a Child Find, in the corner of a Child Find center. And the mom might bring over some toys and you might be playing with the child with some toys. You might be able to see fixation right then using some of her own toys or a snack that the child is using. Horizontal and vertical pursuit, those are two separate sub areas. You present a target slowly in a horizontal direction and move it first right and then left and see if the child can follow it in a horizontal direction and in a vertical direction. And saccadic eye movements, you present one target centrally. This is actually the only little bit of a tricky area that you need to kind of -- I need to kind of think about. You present a target centrally and then you present another target and bring it in from the side. And move away the first target that was presented centrally and repeat the process. Bringing a second target in from the right and then move the central target away again. And see if the child can re-position their eyes and look at that second target that is being presented. And we're going to have plenty of practice on all of these during the training. If you can go on to the next slide, I think we have a little video now. 

>>Hillary: Yes. I'm going to stop sharing because my video was not playing nicely with Zoom. 

>>I'm ready. 

>>Hillary: Okay. 

[Music Playing] 

>>Under the category visual motor component, we'll be working on fixation. Use one of the following materials. Either a white ball with a black X, the human face, or a face figure. Present the target and observe if the young child demonstrates immediate evidence of visual fixation. You'll want to note the scoring for this item. You would give a zero if there is immediate evidence of visual fixation to any of the targets. You would give a 1 if it's not appropriate for this item. You would give a 2 if there's no evidence of visual fixation. If you're scoring a 1 for the young child and the target is not appropriate, try a different target. It might need to be a familiar target to this young child. 

[End of video] 

>>Diane: That was a wonderful little child that is the daughter of one of the TSBVI employees and we were so grateful that she brought her in to use as a subject. So you could see that she definitely fixated very, very quickly. And I didn't just use the X balls, I think I used a little chip at first and then a tangerine or something. And her sippy cup as well. So you can use other items for some of these. Okay. Go on to the next slide. Yes. Thank you, Hillary. We're still talking about interactive, the interactive pieces of this screening device. We are moving down to the visual perception -- excuse me, perceptual visual component section. And these are the three -- or four interactive areas here. Contrast sensitivity. We're going to be using the Hiding Heidi for that one. And I think many of you are familiar with how we take a look at contrast sensitivity. You'll get a lot of practice during the training. Visual acuity, at first glance you're kind of thinking visual acuity, wait a second. How can we get a visual acuity score? But it's really not a visual acuity score. We're using those LEA Grating Paddles. We present the full paddle to the front and hide the 4.0 paddle behind the full gray paddle. Silently you split the two paddles so that both are showing. You can move them up, down, left, right. And the young child should shift their gaze, or at least give a quick glance towards the 4.0 paddle. If you're familiar with using those LEA Grating Paddles, this will be fairly simple for you. But, again, we will give lots of practice during the training session. Visual field. Again, you might be thinking, oh, my gosh. How are we going to test visual field on a young infant? But we use our face. We use a central target, like our face or the red ball, this red ball, for example. And we move it to the left visual field. We observe to see whether the child is shifting their gaze to that target in a visual field. We repeat it several times. And you're just documenting whether they can shift their gaze and look at a target over in a left visual field, right visual field, lower, or upper visual field. And then that last area is that optokinetic nystagmus. We're using the optokinetic drum -- it's not a drum. It's the app that we would recommend that you get. You put it on an iPad and you're watching to see if the child can follow the lines at a certain speed and then reshift their gaze back to the beginning line. And then follow the lines and then jump back to a beginning line. And children can do this right away at birth. It's an early thing that they can do. I think we have one more film that we're going to have to switch over to Nathan to show us here. 

>>Kaycee: While Nathan is pulling that up, we had a quick question. You mentioned the red reflex earlier. Lori was curious. Does a child with CVI typically show a lack of a red reflex? Is that why that's in there? 

>>Diane: Well, it's even actually more complex than that. There are other things that you might notice and see. I think that we would leave it at that. It's kind of detailed. I would prefer to go into it at the training, if that's okay. Hillary, did you want to add anything more on that? I think we just need to go into that at the training. 

>>Hillary: Lynne added in a comment in the chat that a white reflection is a huge red flag because that could indicate neuroblastoma. But most kiddos have the red. 

>>Diane: You want to be careful about that and we'll talk in depth more about that. Remember, we're not diagnosing anything, we're just observing and we're seeing what the results are of those observations and then we report it. So I think that we'll go into more detail on that during the training. 

>>All right. You guys ready for the video? 

>>Diane: Yes. 

>>Okay.

[Video]
[Music Playing] 

>>Diane: In the visual acuity component, you will use either the Teller acuity card 2070 or the LEA Grating Paddles 4.0 CPCM. For example, using the LEA Grating Paddles, present the full gray paddle to the front, hiding that 4.0 paddle behind. Then, very quietly without sound, split the two paddles so both are showing. You can move them apart either up, down, left, or right. The young child should shift their gaze, or at least give a quick glance towards the grating paddle. Or if, if you're using the Teller card, the Teller card. Doing this just once is enough. Please note that this procedure is not to obtain a visual acuity, only to verify that the threshold is there and that the baby can see it. 

[End of video] 

>>Diane: Thank you, Nathan. 

>>Hillary: One second and I'll get our slides back up. Diane, I think we have five-ish minutes left. 

>>Diane: Okay. Okay. I can be quick. Okay. The next slide, Hillary. 

>>Hillary: Yes, ma'am. 

>>Diane: Okay. So I just wanted to show you this slide here real quick because I want to show you the areas that you can look at just as observations. And not be doing any messing with the kit. And if you can get a score of 6 just by doing these, then you stop. Again, take a look at where pupillary light reflex and red reflex is at the top of this list. We really want to do those two last of all of these different things. This is a very quick, easy to use screening device. We've highlighted those to show that you can even just observe just those right off the bat. And you'll get a score. And you might be able to stop right then. So, next slide please, Hillary. And so just to remind you, again, it's a total score of 6 or over indicates risk and the child should be seen by an ophthalmologist. Hillary, you want to take over? Oh, no. Me. Are there any questions at this point? Any new questions? Uh-oh. Okay. Yeah. The video was on. Okay. You were asking about the OKN drum. No. We don't need to buy the OKN drum. It's cheaper to buy the app and have it on your smartphone or on your iPad. And there are two types of apps. It will be on the list of the supplies when you take the training. And we can get that to you then. Hillary will be talking about the training in just a second, to add to that question. 

>>Hillary: I will just really quickly say that someone asked about the study where babies were recognizing face -- kind of facial features. So that link's in the chat. And then another resource that I like for babies, babies are ready for social interaction. They are born connected to people already, and that's from Suzanne. That's in the chat. So the training. In answer to your question really quickly Diana, no. This training is not available virtually because it requires the hands-on practice with the components. Because in order for this to be really valid -- well, I say "valid," you need to practice to do it the correct way. Which for us vision professionals who have been doing CVI testing for many years, is actually a little challenging. Because I wanted to move things and help the baby. No. You can't do that. It's got to be done in a certain way, so you've got to practice. So here's what we in Texas are doing. We are currently teaming with organizations to train others. For example, our Education Service Centers in Texas, for those of you outside of Texas, we have 20 Education Service Centers because Texas is so big and wonderful. And we're partnering with those folks to get the training of trainers out there. And we're investigating opportunities to train early childhood intervention specialists and medical staff. We'll be doing a training later this month that is going to be a combination of Education Service Center and early childhood intervention staff. Looking at another -- talking to several other folks about that, so hopefully that will be coming. And we, again, have some inroads with some big medical facilities and are trying to make more inroads so if you know someone, happen to have a friend in that field, feel free to share with them this wonderful information and let them know the NAVEG is out there and feel free to connect them to us. So basically the options that you have are training screeners. So we can train people to be screeners. And we can train people to be -- training of trainers so they can go out and train others. And we also can provide ongoing support. And then we had -- so where will the training be provided? Well, in Texas we go all over Texas and provide that training. We can potentially travel out of state -- and that would -- there would with conversations about that. But we can train out of state. But in Texas you would have to talk to your Education Service Center. Or if you're a large school district and you would like us to come out, the easiest thing to do -- and I can't open my screen right now, so, Kaycee, if you want to put it in consultation request or request training from TSBVI, there's a simple Google form that will take you five minutes to fill out and someone will reach out to you and we can talk about the logistics and the specifics. Thank you. That is now in the chat. And appreciate that. And the cost is going to be dependent on where you are and what exactly you need. That is something that is negotiable. We are grant funded so really mostly what we ask people to cover is our travel costs. And it just depends on the travel costs themselves. And so our administrators get to talk about that and get that sorted out. But we will definitely give you a quote. I'm sorry. I can't give you a great ballpark. It depends on several factors and travel is the great big one. I'm glad, Andrea, that you would love to take the training. The information is in the handouts and you can certainly reach out to us individually or you can fill out a form. Again, here's our information. Diane is strategytosee @gmail.com. Maybe region 20 has an assessment training for 0-3. It's not anything right now but maybe get with Mari and see if we can be added to that, if that's -- that may or may not be what they're talking about. Maybe more regular assessment. 

>>Diane: As far as the presenters, there is a small group of us. I am fortunate enough to be included with the Outreach group with TSBVI, which I absolutely love. But there's a small group of us that some subset go out and do the training, just depending upon schedules and who's available. But it would be two to four of us doing the presenting, depending upon how many people are in the audience. And the date and how it works out with everybody's schedule. 

>>Hillary: I'll just add that Anchor Center does training too. If you're in another state, Anchor Center is another option. 

>>Kaycee: Awesome. Thank you both so much for this training. I see there's some other states that have already started doing the screenings, which is really exciting. Thanks for sharing that in the chat as well. We've got those resources, a link to request information or training from Outreach that we put in the chat. And also the handouts, so make sure you grab those. I'm going to go ahead and give the code for today's session in case anybody needs to