early hearing detection: collaboration and outcomes
DESCRIPTION
T. Carroll presentation given at the 2012 South Carolina Home Visiting SummitTRANSCRIPT
Early Hearing Detection and Intervention:
Opportunities for Collaboration to Impact
Outcomes
Why Do Newborn Hearing Screening…… Hearing loss is the most frequent
occurring birth defect
Hearin
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ects
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10
20
30
Incidence Per 10,000 Births
Why Do Newborn Hearing Screening…… Hearing loss is the most frequent
occurring birth defect Undetected hearing loss in children
has serious negative consequences Poorer academic achievement Reduced educational and social
opportunities Increased cost in special education Miss the “critical window” for language
acquisition Birth – 2 y.o.
Why Do Newborn Hearing Screening……
0.8 1.2 1.8 2.2 2.8 3.2 3.8 4.2 4.80
1
2
3
4
5
6
Identified <6 mos (n = 25)
Identified >6 mos (n = 104)
Age (yrs)
Lan
gu
age
Ag
e (y
rs)
Boys Town National Research Hospital Study of Earlier vs. Later
Moeller, M.P. (1997). Personal communication, [email protected]
Why Do Newborn Hearing Screening……
13-18 mos(n = 15/8)
19-24 mos(n = 12/16)
25-30 mos(n = 11/20)
31-36 mos(n = 8/19)
0
50
100
150
200
250
300
Identified BEFORE 6 Months
Identified AFTER 6 Months
Vocabulary Size for Hearing Impaired Children Identified Before and After 6 Months of Age
Chronological Age in Months
Vo
cab
ula
ry S
ize
SC Legislation – 1976 Code Section 44-37-40"Universal Newborn Hearing Screening and Intervention Act"
Effective June 30, 2001 All hospitals required to screen
newborns during birth admission for hearing loss Exception: Hospitals with less than average
of 100 births annually All hospitals required to give parents
educational information regarding the importance of hearing screening regardless of number of births (April 1, 2001)
SC Legislation – 1976 Code Section 44-37-40"Universal Newborn Hearing Screening and Intervention Act"
Follow Up All babies referred by
hospital screening are to receive: Audiologic Evaluation
by Audiologist, or Medical Evaluation by
Physician or Otolaryngologist, or
Both if indicated Confirmed HL:
Medical Intervention Audiologic Habilitation Early Intervention
services Augmentative Hearing
Devices
Reporting & Monitoring NBHS reporting
procedures must be followed by: Hospitals Audiologists Early Interventionists
SC Legislation – 1976 Code Section 44-37-40"Universal Newborn Hearing Screening and Intervention Act"
Miscellaneous Establish Advisory Council to include reps
from: Agencies Professional Disciplines Hospitals Consumers
DHHS shall provide reimbursement DHEC shall provide reimbursement
First Sound Process
Hospital
Hearing
Screening
Fail
Pass
Literature
Referred to Audiologist for
Re-ScreenFail
Pass
Literature
AudiologyDiagnostic Evaluation
Normal
Literature
CHL
Refer to BabyNet
Habilitation Recs
Hearing AidsCI
Sign Lang
Parent Support
DATA COLLECTION
HOSPITALS Started with paper
data collection ~ 2003 began
electronic data collection
April 1, 2008 data collection process integrated with Vital Records
Report screening results on every baby
AUDIOLOGISTS Started with paper
data collection ~ 2003 began
electronic data collection
Report results of any newborn referred by hospital for follow up
How Do We Test Babies?
?????
How Do We Test Babies?
How Do We Test Babies?
Two types of tests can be done on newborns:
Auditory Brainstem Response (ABR) Tests the infant’s ability to hear soft
sound through miniature earphones Sensors measure baby’s brainwaves
to determine if the sounds are heard normally
Otoacoustic Emissions (OAE) Measured directly with a miniature
microphone Measures response coming from
inner hair cells
Goals of EHDI
1 – 3 - 6 Screen by 1 month old
Confirmed diagnosis by 3 months old
In Early Intervention by 6 months old
How Are We Doing?
AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 201190%91%92%93%94%95%96%97%98%99%
100%
95%
93%
97% 97%98%
99%
97% 97% 97%96% 96%
Screening Rate
How Are We Doing?
2002 2003 2004 2005 2006 2007 2008 2009 2010 20110
20
40
60
80
100
120
74
106
85
6877 75
82
62 58
40
Confirmed HL
How Are We Doing?
AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 20110%
20%
40%
60%
80%
100%
120%100%
51%63%
88%
38%
58%49%
60%53%
43%
EI by 6 mos old
How Are We Doing?
2003 2004 2005 2006 2007 2008 2009 2010 20110%5%
10%15%20%25%30%35%40%45%50%
29%
38%43%
21% 23% 23%
32%37%
33%
Lost to Follow-Up/Documentation
Things to Celebrate 100% labor and delivery hospitals conduct
screenings
More than 55,000 babies are screened each year prior to discharge
Data reporting system linked to vital records
Things to Improve
Follow up rates for failed screen
Data reporting
Parent support
Collaboration Opportunities Home Visitation & ECHO Programs
Report Screening
Results
Report Diagnostic
Results
Report Need for Further Follow Up
Audiology Resource
Verification of Screening
Results
FIRST SOUND
Questions?
Tara Carroll, MCD, CCC/A
First Sound Program Manager/Audiologist
803-898-0708