Early Childhood Hearing Early Childhood Hearing Screening:Screening:

The Next Step For EHDI’s?The Next Step For EHDI’s?

The National Center for Hearing The National Center for Hearing Assessment & Management (NCHAM) Assessment & Management (NCHAM)

at Utah State Universityat Utah State University

NCHAM serves as the Maternal and Child Health Bureau’s National Technical Assistance system to help hospitals, states, and professionals implement and improve comprehensive and effective Early Hearing Detection and Intervention (EHDI) programs.

Working together, we have achieved significant advances in our ability to screen newborns for hearing loss.

Technological advances in the past 10 years have made Technological advances in the past 10 years have made it possible to conduct it possible to conduct highly reliablehighly reliable physiological physiological hearing screening of children as young as a few hours hearing screening of children as young as a few hours

old. Hearing screening equipment has become:old. Hearing screening equipment has become:

More affordable

More portable Easier to use

Advances in TechnologyAdvances in Technology

Otoacoustic Emissions (OAE) ScreeningOtoacoustic Emissions (OAE) Screening

OAE Hearing Screening is ideal for screening young children because it:

Is painless for the child

Requires no behavioral response

Is quick and efficient to administer

Can be performed by anyone skilled in working with children and trained to do the procedure

Can help identify the potential presence of ear infections as well as permanent hearing losses

Demonstration of the OAE Screening process

Otoacoustic Emissions (OAE) ScreeningOtoacoustic Emissions (OAE) Screening

Why is Continuous Hearing Why is Continuous Hearing Screening so Important? Screening so Important?

As many as 50% of infants who refer from newborn hearing screening are lost to follow-up.

Hearing loss can occur at any time in a child’s life.

Approximately 35% of preschool children will have repeated ear infections before 3 years of age, sometimes resulting in fluctuating conductive hearing loss.

Without regular, physiologic screening, hearing loss is often impossible to detect.

Status of Head Start Hearing Status of Head Start Hearing Screening PracticesScreening Practices

Head Start’s “Performance Standards” reflect a long-standing commitment to hearing screening: All children are to receive a hearing screen within 45 days of enrollment; however:

Most Grantees are relying on subjective, outdated screening methods such as hand clapping, bell ringing, and parent questionnaires to screen children 0 – 3 years of age.

Most Grantees are unaware that Otoacoustic Emissions (OAE) technology, used widely in newborn hearing screening programs, can also be used successfully in early childhood settings.

Status of Head Start Hearing Status of Head Start Hearing Screening PracticesScreening Practices

Head Start’s “Performance Standards” reflect a long-standing commitment to hearing screening: All children are to receive a hearing screen within 45 days of enrollment; however:

Most Grantees are relying on subjective, outdated screening methods such as hand clapping, bell ringing, and parent questionnaires to screen children 0 – 3 years of age and/or physician physical exam.

Most Grantees are unaware that Otoacoustic Emissions (OAE) technology, used widely in newborn hearing screening programs, can also be used successfully in early childhood settings.

From 2001 – 2004, NCHAM has been conducting a pilot

project helping Grantees. . .

Migrant Head Start American Indian Head Start Early Head Start

. . . update hearing screening practices for children 0 - 3 . . . update hearing screening practices for children 0 - 3 years of age using OAE technology.years of age using OAE technology.

The Hearing Head Start ProjectThe Hearing Head Start Project

Hearing Head Start Project Hearing Head Start Project Participants in UT, WA, and OR :Participants in UT, WA, and OR :

Receive training and OAE equipment

Conduct OAE screening on all children 0 - 3 years of age following a prescribed protocol

Document screening and follow-up outcomes; submit data on a regular basis

Receive ongoing technical assistance and linkage with additional hearing resources

104 Migrant, American Indian, and Early Head Start staff trained

Representing 19 grantees (69 program sites) in WA, OR, and UT

Using 36 pieces of OAE equipment

The Hearing Head Start Project --The Hearing Head Start Project --Outcomes to Date: Outcomes to Date:

Almost 3000 children screened

OAE Screening/Referral OutcomesOAE Screening/Referral Outcomes

2953 children screened (using a 3 - step screening protocol)

183 (6%) were referred for medical/audiological follow-up

(60 currently “in process” to receive initial follow-up)

60 identified with a hearing loss or disorder

11 being monitored/diagnosis unknown

12 normal/no treatment required

27 lost to follow-up or parent refused follow-up

OAE Screening/Referral OutcomesOAE Screening/Referral Outcomes

Of the 60 identified with a hearing loss or disorder:

1 severe, bilateral, sensorineural loss

2 mild-moderate, bilateral, permanent conductive losses

8 bilateral, fluctuating conductive losses requiring treatment

41 otitis media (ear infection) requiring treatment

1 treated for occluded Pressure Equalization tubes

1 treated for perforated eardrum

6 treated for excessive ear wax

Qualitative ResultsQualitative Results

Grantees report that they prefer OAE screening over previous methods because it:

Is quick (averages 5 minutes per child), reliable, and incurs no additional personnel costs; can be done by CNAs, health coordinators, disability specialists, nursing professionals, home visitors, family advocates and other early childhood staff

Builds confidence that their hearing screening approach is based on sound audiological practices

Expedites referral for follow-up; contributes significantly to the child’s Medical Home because OAE screening is not currently available in most health care provider offices/clinics

Contributes to community hearing health as information is shared with Part C providers, Community Health Clinics and health care providers.

Is purchasing OAE Equipment all that is Is purchasing OAE Equipment all that is needed for Head Start Grantees to needed for Head Start Grantees to successfully update their hearing screening successfully update their hearing screening practices?practices?

No, equipment is not enough. It is vital that Grantees be provided with:

Audiological supervision Training An appropriate screening & follow-up protocol Ongoing technical assistance & linkage to

local/state hearing resources

Without training, audiological supervision and Without training, audiological supervision and an appropriate screening protocol, Grantees are an appropriate screening protocol, Grantees are

likely to experience problems related to:likely to experience problems related to:

Inappropriate selection of/care of screening equipment

High refer rates – over-referral to physicians/audiologists

OAE technology misconstrued as a diagnostic tool

Confusion over the screener’s role/limitations

Under-identification of hearing loss and other disorders

Inappropriate follow-up diagnostic and intervention services

Essential Elements of the Training ProcessEssential Elements of the Training Process

Supervised by a pediatric audiologist assisted by other experienced screeners; incorporates large group instruction, small group coaching (1:5) and individual assistance

Hosted at Grantee site where participants experience supervised “hands-on” screening practice (and Grantee children are screened as an extra benefit!)

Structured around audio-visual and written materials that standardize the training, are responsive to multiple learning styles (participants receive their own copy of the materials for refresher/retraining purposes)

Requires approximately 6 hours to complete

Essential Elements of the Screening ProtocolEssential Elements of the Screening Protocol

Reduces over-referral to physicians/audiologists, while promoting timely referral as needed

Screens for hearing health concerns in the outer, middle and inner ear

Essential Elements of the Screening ProtocolEssential Elements of the Screening Protocol

Screening and Follow-up Forms (provided to screeners to document screening results) reflect the screening protocol

Screeners are visually prompted on the correct “next step” in the protocol

Ongoing Technical Assistance TopicsOngoing Technical Assistance Topics

Acceptable refer rates; how to improve screening; strategies for screening in homes

Acceptable modifications to the protocol (sometimes needed in remote/rural areas)

Equipment care and concerns Establishing relationships with local audiologists and

medical providers Clarifying the Medical Home concept Responding to primary care provider questions &

concerns about the OAE screening Reviewing individual cases of children requiring

rescreening or follow-up Understanding follow-up medical/audiological

recommendations

Sustainability & ReplicabilitySustainability & Replicability

Establish ECHO Teams that will “echo” the training and technical assistance activities of the original Hearing Head Start Pilot Project

Team

Early Childhood Hearing Outreach

During 2003 – 2004, NCHAM’s Hearing Head Start Team has begun working with existing state-based Early Hearing Detection and Intervention (EHDI) programs and other stakeholders to:

Sustain and expand early childhood OAE hearing screening activities in Oregon, Utah and Washington, providing ongoing technical assistance to Grantees

Initiate early childhood OAE hearing screening activities in Kansas and North Carolina

State-based ECHO teams will:State-based ECHO teams will:

Sustainability & ReplicabilitySustainability & Replicability

To enable ECHO To enable ECHO teams, the teams, the NCHAM Hearing NCHAM Hearing Head Start Team Head Start Team created and created and refined a refined a comprehensive comprehensive training packagetraining package

Sustainability & ReplicabilitySustainability & Replicability

Hearing Screening & Follow-up Diagnostic Forms

Getting a Hearing Head Start: Updating Early Childhood Hearing Screening --Program Screening Guide (for Grantees)

Getting a Hearing Head Start: Updating Early Childhood Hearing Screening Practices -- Training Video (four-part training video reproduced in CD-ROM and VHS formats)

The (((ECHO))) Team Training and Technical Assistance Manual -- outlining 14 implementation steps for establishing ECHO Teams, collaborating with state hearing-health stakeholders, and providing training & ongoing technical assistance to Grantees.

The comprehensive training package includes:The comprehensive training package includes:

Sustainability & ReplicabilitySustainability & Replicability

Familiarize ECHO Teams with concepts, materials and resources

Model the training process

Assist ECHO Teams in developing implementation plans

NCHAM Hearing Head Start Team NCHAM Hearing Head Start Team provided a 2-day training workshop to provided a 2-day training workshop to ECHO Teams to:ECHO Teams to:

ECHO Team PreparationECHO Team Preparation

Provide ongoing technical assistance to Grantees engaged in OAE screenings

Provide initial training to at least 5 new Grantees

Provide basic information to all Head Start Grantees in the state serving children 0 - 3 years of age

Assist in data collection of screening results

Develop plan for sustainability

Establish linkages between newborn hearing screening and early childhood hearing screening activities in the state

ECHO Team ActivitiesECHO Team Activities

Parents say it the best…Parents say it the best…

Who can help put the pieces together Who can help put the pieces together so that so that ALLALL young children can . . . . young children can . . . .

. . . receive the benefit of high-quality, . . . receive the benefit of high-quality, early and continuous hearing screening???early and continuous hearing screening???

WE CAN!Head Start Regional Offices

Head Start State Collaboration Offices

Head Start Technical Assistance Providers

Migrant, American Indian and Early Head Start Grantees

State Early Hearing, Detection and Intervention (EHDI) Programs

Part C Providers, Community Health Clinics, Indian Health Services

Parents and Professional Organizations

a 501c(3) non-profit organization working on behalf of all children and families

www.infanthearing.org