Bringing Eye Care to Poor Children in Alabama

A Profile of Stephen F. Black, JD, an RWJF Community Health Leader, 2008

    • May 29, 2013

In 2008, RWJF named Stephen F. Black an RWJF Community Health Leader in recognition of his work as founder and president of Impact Alabama, a statewide nonprofit that collaborates with 25 colleges, universities, and communities throughout Alabama to develop and implement substantive service-learning projects designed to engage students in addressing human and community needs and enhance students’ senses of social and civic responsibility.

FocusFirst, a signature initiative of Impact Alabama, provides a cost-effective direct response to the vision problems of children who live in urban and rural areas by conducting high-tech screenings and analysis and connecting all children who fail the screening with comprehensive follow-up care.

The problem. Poor vision adversely affects tens of thousands of children in Alabama each year, leading to a substandard education, behavioral risks, and low self-esteem. This is largely the result of poor public awareness about the importance of eye care in young children and the inability of children to recognize their own vision problems. These problems are heightened in families from economically disadvantaged backgrounds by financial hardship and lack of access to appropriate medical care.

Vision screenings are most effective during the preschool years when early identification and treatment of many conditions can prevent irreversible vision damage or loss. Unfortunately, although many children in day care, pre-K, and Head Start programs are known to need eye care, the vast majority go without it. This is largely because young children are hard to reach in large numbers before they begin public schools. Marshaling a network of college student volunteers and recent college graduates, Black has been able to transform the provision of vision care for young children in all 67 counties of Alabama.

Returning to his roots. Stephen Black was born and grew up in Albuquerque, N.M., but while many people are drawn to the Southwest by its natural beauty, this somehow didn’t appeal to Black. “It looked to me to be just brown and barren,” he said. He also missed being in a place where many people could trace their roots back several generations. In the Southwest, he noted, this is mostly true only of Native Americans.

It was different when he visited his ancestral home of Alabama. “I loved it. I would think, ‘This is just where I’m supposed to be.’ It was a feeling of rootedness, of work to be done.”

The Black name looms large in Alabama—and American—history. Stephen Black’s grandfather Hugo Black served as a U.S. Supreme Court Justice from 1937 to 1971, and several of his votes on the court, particularly the Brown v. Board of Education school desegregation decision of 1954, were so unpopular, that some family members were made to feel uncomfortable enough to want to leave Alabama. One of them was his son Sterling Foster Black, who moved to New Mexico, where he practiced law and became a state senator. He met Nancy Lee Hirsch there, a psychologist who would become his wife. Their son Stephen Black was born in 1970.

Hugo Black had always hoped that some of his 13 grandchildren would return to Alabama. But only Stephen would do so. As a teenager Stephen spent time in the state, staying with an aunt, civil rights advocate Virginia Durr. He entered Boston University and later told the Gadsden Times in Alabama: “By the time my freshman year was over, I knew I wanted to come back.” He transferred to the University of Pennsylvania, graduated from there and from Yale Law School, settled in an old house in Birmingham near where his father had lived, and joined a law firm there.

A vision of service. “I was honest with the firm,” Black said. “I told them I didn't want to be a partner. I wanted to be in public policy as soon as I could.” He soon left the firm to work for then-Governor Don Siegelman on economic policy issues, and then launched an unsuccessful campaign for state treasurer, running on a platform supporting a more progressive tax system for the state.

By this time, Black had been deeply affected by the enthusiasm of thousands of college students he had spoken to in his travels across the state. “When I was at Penn, there was no such thing as service learning,” he said. “I saw it as something with a potential to make a lot of difference in the state.”

In 2004, he founded Impact Alabama, a nonprofit providing college students with structured service learning projects designed to promote civic responsibility and develop their leadership potential. The following year he founded the Center for Ethics & Social Responsibility at the University of Alabama, which houses Impact Alabama.

Impact Alabama students and its staff have achieved incredible successes through four primary initiatives:

  • SaveFirst, which has prepared tax returns for more than 22,000 working families, helping them to claim $42 million in refunds and save $5 million in commercial preparation fees.
  • SpeakFirst, which enriches the academic experience of gifted students from Birmingham area high schools through participation in an “all-star” debate team. SpeakFirst’s first five graduating classes (22 students) have earned more than $3 million in college scholarships, and all students who complete at least three years of the program earn a full tuition scholarship to the University of Alabama, at Birmingham, or at Huntsville.
  • CollegeFirst, which trains college and graduate students to implement a three-week, summer advanced placement institute for high-school students in Birmingham, Huntsville, and Tuscaloosa. Over 500 high school students have completed the program so far.
  • FocusFirst, which has provided vision screening to more than 175,000 preschoolers as young as 16 months. Some 10 percent of the children failed the screening and were connected with free or subsidized follow-up care as necessary.

FocusFirst brings eye care to kids. “I wanted to create a health care initiative for college students to participate in,” Black said. “I wanted to give the students a personalized experience with the idea of health care disparities rather than just lecturing them about it. I wanted to put them in low-income communities and let them feel it.”

Black thought about dental care but realized that, without advanced training, there was little students could do about that. Then he began reading about vision care and learned that significant gaps in care still exist around the country. “It makes your stomach hurt to think of all the kids going permanently blind from something that’s easy to deal with,” he said.

Four years earlier, an Eye Health Needs Assessment for the Alabama Eye Institute had found that only 21 percent of preschool children were receiving comprehensive vision screenings. Finances and geography were formidable barriers. “Thousands of Alabama's children grow up in rural areas of the state,” the report said, “distant from any eye service providers, often with no means of transportation to obtain needed eye care.”

Students find path to service. At first, Black found prospective funders skeptical that college students were the way to deal with the problem, but he forged ahead. “If you put 18- to 25-year-olds on a path to do service,” he said, “they'll take advantage of it.”

Black assembled a team of four recent college graduates and developed a strong partnership with Vision Research Corporation, which provided several high-tech photo optic scan cameras as in-kind support. He and his team recruited college student volunteers and trained them to use the cameras. “In a short time, they get really good at the equipment,” he said. “This is high-tech vision screening, not just having little kids read eye charts.” This distinction is important: technologically advanced screening processes can find severe problems such as cataracts, amblyopia (lazy eye, which is characterized by an impaired vision in an eye that otherwise appears normal), and near- and farsightedness that eye charts could not possibly detect—especially in children who cannot respond to examiners’ prompts.

Since 2004, Impact Alabama has grown to a staff of thirty-three, most of whom are one or two years out of college serving as AmeriCorps members with the organization. In its first year, FocusFirst provided vision screenings to 4,600 children. Today, FocusFirst conducts 1,100 screenings for more than 34,000 children annually.

Getting children treated has actually been the easiest part of the project, Black found. Many of the children qualify for government assistance and for those who don’t, private practitioners and nonprofits such as the Alabama-based SightSavers have been willing to step in with assistance ranging from eyeglasses to cataract surgery.

RWJF Community Health Leader perspective: Black used the personal portion of his award—$20,000—to pay off student loans and put the remaining $105,000 into expanding FocusFirst to reach more children.

The award “has been a huge help to our work, to raise the profile of it,” he said. “It’s been incredibly gratifying. It’s helped us screen tens of thousands of additional kids. We get to a large percentage, but we don’t get to them all.”

At some point, he hopes he will no longer have to say that.

RWJF Perspective: RWJF recognized the first 10 Community Health Leaders in 1993. They are unsung and inspiring individuals who work in their communities—often among the most disenfranchised populations—to address some of the nation’s most intractable health care problems. The formal recognition of these Robert Wood Johnson Foundation Community Health Leaders and their programs often launches them to greater levels of influence and extends their reach to serve more vulnerable populations. For more information on the program see Program Results.

Under the RWJF Community Health Leaders Award, each year RWJF has provided a $125,000 award to 10 individuals and their organizations ($105,000 supports a project at their organization and $20,000 goes directly to the leader for personal development). RWJF also connects the RWJF Community Health Leaders with each other so they can continue their work with the support and experience of their peers and previous award winners.

“Community Health Leaders are characterized by three specific traits—they are courageous, they are creative, and they are committed,” says National Program Director Janice Ford Griffin. "The Foundation recognizes the tremendous resource of experience among the leaders and we look forward to mining that resource as we consider future initiatives."

“Through the Robert Wood Johnson Foundation Community Health Leaders award , we at the Foundation have the opportunity to recognize innovative and courageous local leaders behind ground-breaking efforts in communities across the United States,” said Sallie George, MPH, program officer at RWJF. “These individuals remind us that one person can have a powerful impact on health and health care within their communities.”

The most recent round of leaders was chosen in the fall of 2012.

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> 10% of Alabama preschoolers screened had vision problems that #FocusFirst addresses

Stephen F. Black, JD

Stephen F. Black, JD
2008 Robert Wood Johnson Foundation Community Health Leader