Overview
Initiative type
Model of Care
Status
Deliver
Published
June 2026
Summary
The PSHRP (Primary School Health Readiness Program) is a statewide school-based vision screening model detecting visual abnormalities and risk of amblyopia. Delivered through a Hub and Spoke model reaching children throughout Queensland communities.
Dates: January 2025 - ongoing
Implementation sites: Queensland Children's Hospital
Aim
To detect vision abnormalities and amblyopia risk factors early in Prep-aged children to optimise their developmental outcomes and improve learning.
Outcomes
- Established statewide vision screening service since 2016 with Registered Nurse workforce across all 14 Hospital and Health Services.
- 400, 490+ children screened since inception
- 30, 679 + children referred for further assessment (average 7.66% referral rate)
- Formal licensing agreements with the Department of Education and five Catholic Dioceses along with local and district partnerships granting access to schools across Queensland
Background
The Primary School Health Readiness Program (PSHRP) was formally established in 2016 to address a critical gap in early childhood vision screening across Queensland. Vision plays a foundational role in learning, reading readiness, and social engagement; undetected amblyopia or other visual abnormalities can have lifelong impacts on educational achievement and developmental outcomes. Early intervention is known to significantly improve long term trajectories, yet prior to PSHRP, Queensland lacked a unified, equitable, statewide approach to vision screening. The growing evidence demonstrating links between early vision and life outcomes drove the need for a consistent model capable of reaching children across metropolitan, regional, rural and remote locations.
This led to the development of the PSNHRP statewide, permanently funded service with legislated recognition. In 2023, PSNHRP as a vision screening service was formally included in the Public Health Act as a Queensland school health service, allowing for more streamlined data sharing between the program and school stakeholders to better support families with consent and follow up. Before statewide rollout, vision screening availability varied substantially across regions. This fragmentation of services, inconsistency in screening methods, and lack of centralised data collection all contributed to inequitable access and gaps in detection rates. The Hub and Spoke model with the central Hub embedded under Children’s Health Queensland (CHQHHS), provides governance, clinical protocols, training, and program oversight. The Hub also manages statewide data via the QVision system, introduced in 2019 to standardise data collection, reporting, monitoring, and evaluation across all Hospital and Health Services (HHS).
The PSNHRP underwent a phased statewide rollout, with all 14 HHSs participating by 2018, ensuring Queensland children had access to high quality, evidence based vision screening. The service also extended screening capacity through formal agreements with the Department of Education and five Catholic Dioceses. Whilst there is still no unified vision screening model nor consistent screening models across all states and territories, PSNHRP is unique in Australia for using dual modality screening with the Parr 4m visual acuity tool and vision spot screener supported by robust confirmatory diagnosis data collection. This method was validated through research demonstrating its effectiveness. The program continues to support evidence-based service improvement. Due to growing concerns about increasing myopia prevalence among older children, the program obtained ethics approval in 2025 to pilot a Screening Older Children Trial with Year 6 students within CHQHHS. This research aims to understand myopia prevalence and explore whether expanded screening may be warranted to better support adolescent learners.
Methods
PSHRP is delivered through a statewide Hub and Spoke model, enabling standardised, high quality service delivery supported by local HHS nursing workforce. The Hub provides program governance, operational oversight, training, protocol development, and statewide performance monitoring. It manages QVision the centralised database established in 2019 ensuring consistent data collection, analysis, and reporting across all HHS regions. The Spokes (HHSs) consisting of approximately 22.7 FTE Registered Nurses. Each nurse is assigned a cluster of schools and is responsible for delivering screening, monitoring follow up, and meeting local screening KPI’s. This statewide RN workforce ensures service accessibility for children across Queensland, from metropolitan to rural and remote areas.
Screening is offered across state, Catholic, and independent schools, supported through a formal licensing agreement with the Department of Education and partnerships with five Catholic Dioceses. This ensures that the program is universally available regardless of school sector or location. The program uses dual modality screening, an approach validated in 2017. Screening equipment includes the Welsh Allen Spot Vision Screener and 4 Parr visual acuity tool, enabling detection of amblyopia and their risk factors. Digital innovation has been central to implementation.
The QVision online consent portal, introduced in 2020, provides families with an accessible digital pathway to submit screening consent, reducing administrative burden and increasing return rates. In 2021, the Online Outcomes Portal was launched, allowing Eye Health Professionals to report referral outcomes directly, enabling improved follow up, data collection, and improved continuity of care. Continuous quality improvement is embedded throughout the service model. A retrospective study was completed in 2023 that validated that the screening protocol developed by the program was effective in identifying visual abnormalities, with higher positive predictive value when both visual acuity and photoscreener were used. The statewide audits also identified areas needing refinement, particularly false
positive referrals generated from “Gaze only” results from the photoscreener. This insight led to the development of the Gaze Rescreen Trial in 2025, aiming to improve accuracy, reduce unnecessary referrals, and decrease anxiety and burden for families with
outcomes to be analysed in 2026.
Discussion
The success of PSNHRP is grounded in the unique combination of single governance and a statewide RN workforce. This service model allows a single set of clinical standards, training requirements, and data processes to be applied consistently across Queensland, while care is delivered by locally employed nurses who understand their communities and can build and maintain local partnerships and relationships. The success and appreciation of this service are reflective through the responses collected in consumer and stakeholder feedback. Key strengths of the service include strong partnerships with Education sectors, legislative support through the Public Health Act, sustained investment and robust data collection.
The implementation of the QVision Online Consent Portal and the Outcomes Portal ensures efficient, timely, and accurate data collection, strengthening clinical decision making and enabling real time monitoring of statewide activity. Lessons learned highlight the importance of regular statewide audits, reflection, and improvement. The retrospective study reviewing the positive predictive value of our screening methods and identification of higher than expected false positives compared to literature benchmarks for ‘Gaze only’ referrals highlights the value of robust data collection. This model is highly adaptable to other Queensland Health settings.
Its Hub and Spoke model and digital integration could be applied to other child focused preventive services. The program’s robust and extensive data driven approach and strong partnerships make it an ideal framework for other statewide initiatives requiring coordinated local delivery. Next steps include completing analysis of the Gaze Rescreen Trial in early 2026 to inform protocol updates, finalising and implementing QVision modifications as a result of the Public Health Act legislative changes and initiating the Year 6 myopia screening pilot. These initiatives demonstrate the program’s commitment to research led service improvement and its readiness to adapt to emerging population health needs.
References
Harris, N., Roche, E., Lee, P., Asper, L., Wiseman, N., Keel, R., Duffy, S. & Sofija, E. (2022): Vision screening outcomes of four to five year-olds reflect the social gradient, Clinical and Experimental Optometry, doi: 10.1080/08164622.2022.2109947
Li Y, Duffy S, Wilks S, Keel R, Beswick R, Dai S. Positive predictive value of dual-modality vision screening in school children 4-7 years of age-a retrospective review in Queensland, Australia. J AAPOS. 2023 Feb;27(1):22.e1-22.e5. doi: 10.1016/j.jaapos.2022.11.009. Epub 2022 Dec 22. PMID: 36565950
Li Y, Duffy S, Wilks S, Keel R, Beswick R, Dai S. Prevalence of visual abnormalities detected through paediatric vision screening in Queensland, Australia. Clin Exp Ophthalmol. 2024;1-8. doi:10.1111/ceo.14448
Key contact
Chantelle Pooley
Clinical Nurse Consultant
Children's Health Queensland
Email: CNC.PSNHRP@health.qld.gov.au