Kindergarten health assessment reports: what do schools really learn from them?

The kindergarten health assessment report (KHAR), mandated by most states, is used to identify children at school entry with any health problems that may interfere with school performance. The objective of this study was to review the completeness and accuracy of the reports that schools receive from health care providers. By analyzing 3,952 KHARs of children enrolled in the Guilford County (North Carolina) Public Schools during the 1999-2000 school year we found that only 20% were fully completed and only 32% recorded results of all 6 required screening tests. Results of the 3 screening tests most applicable to school readiness: vision, hearing, and developmental screening, were documented only 55% of the time. Providers failed to properly classify 75% of children who were either underweight or overweight. Abnormal vision screening results were noted in 485 (14.2%) children, of whom only 38% were recommended for follow-up. Results of vision and hearing screening were recorded in only 50% of children noted to have developmental concerns. The information recorded on the kindergarten health assessment forms is incomplete and frequently inaccurate. These findings arouse concern, given that these forms constitute the basis for school districts to identify those children who may have medical problems.