OBJECTIVES: The follow-up rate among children with vision problems in our outreach programs has been poor (<5%). We therefore developed the Children’s Eye Care Adherence Program (CECAP) for Philadelphia school children, a social worker (SW) intervention to address barriers to care among children with significant vision problems. The objective of this study was to measure CECAP’s effectiveness and cost. We also sought to identify barriers to care through a conceptual framework and geomapping software.    METHODS: CECAP included SW review of records to identify children needing follow-up. SW phoned families to identify and resolve barriers to eye care and scheduled appointment. Effectiveness was defined as the percent completing ≥1 follow-up visit within the physician-recommended time frame. Cost was measured using SW time logs (converted to costs using SW wage rates + benefits) and additional materials (forms, postage, phone charges). Barriers were organized into a conceptual framework depicting 3 main themes (predisposing factors, system factors, and ability to pay) and mapping software to visually illustrate follow-up rate.   RESULTS: Of 1200 patients, 120 required follow-up ophthalmic care in 2012-13. 71 patients were reached and completed a follow-up (59.2%); 49 patients were reached but did not follow-up (40.8%). SW time was ~3hrs/patient for those who followed up and ~2hrs/patient for those that did not. Based on the CECAP program total cost ($14,249) and the reimbursement payment ($6,265.66), the net cost of the CECAP program was $7,983.59. Predisposing factors (lack of awareness, level of perceived importance, conflict of commitment, lack of means of communication) was the primary barrier theme for patients that did not follow-up.     CONCLUSIONS: CECAP significantly improved adherence to eye care but comes at an additional cost. Future efforts should focus on reducing operational efficiencies (e.g., capping outreach attempts) and targeting CECAP based on predictors of follow-up.