Is Early Intervention Is Early Intervention Necessary for All?Necessary for All?

Ruth Fox, RN, MS, New Hampshire EHDI Program CoordinatorRuth Fox, RN, MS, New Hampshire EHDI Program CoordinatorMary Jane Sullivan, Au D, New Hampshire EHDI Consulting AudiologistMary Jane Sullivan, Au D, New Hampshire EHDI Consulting Audiologist

Janet Halley, OTR/L, Director, MICE ProgramJanet Halley, OTR/L, Director, MICE Program

Who are we?Who are we?

• New Hampshire has approximately 14,000 births/year

• 23 Birthing Hospitals• 42 infants with hearing loss identified in 2006

EHDI in New HampshireEHDI in New Hampshire

• All birth hospitals are screening without a legislative mandate

• Administrative rules require hospital reporting

• Diagnostic Audiology Centers located throughout the state for infant follow-up

Life before EHDI (Pre 2000)Life before EHDI (Pre 2000)

• Services for ages 0-3 with suspected or confirmed visual or hearing deficit through:– Multi-Sensory Intervention through

Consultation & Education (MICE) Program– Automatic referral to NH Early Supports and

Services for intake and developmental services

• Few referrals due to limited screening

Impact of EHDIImpact of EHDI

• Increase in referrals of younger children– 22 infants and toddlers enrolled in 2004– 35 infants and toddlers enrolled in 2005*– 36 infants and toddlers enrolled in 2006*

* Increase due to referrals from newborn hearing screening

Impact of EHDI (cont.)Impact of EHDI (cont.)

• Referrals included diagnoses not previously identified in this age group

• Parental resistance to early supports & services enrollment process

• M.I.C.E. resources limited

The Big QuestionsThe Big Questions

• Did all infants with any degree of hearing loss need direct intervention services?

• If not, who would be offered monitoring and who would be offered more intensive direct services?

The ResearchThe Research• The Joint Committee on Infant Hearing

recommends enrollment in interdisciplinaryfamily-centered intervention before 6 months of age.

Literature on impact of minimal hearing loss unilateral or bilateral focused on educational performance. See review of articles at http://www.cdc.gov/ncbddd/ehdi/unilateralhi.htm#summaries

The PlanThe Plan

• Monitoring versus Direct Service

• Monitoring indicated when: – No other known medical conditions– Mild unilateral sensorineural loss– Mild bilateral or unilateral potentially treatable

conductive loss– Infants with suspected but not yet defined hearing

loss– Monitoring request indicated on audiologists report

Monitoring ServicesMonitoring Services

• Initial phone contact with family

• One home visit and/or monthly phone consult with family

• Information packet given to family

• Audiological services as recommended

Direct ServicesDirect Services

• Phone contact with M.I.C.E. staff

• Scheduled home visits by M.I.C.E. staff

• Contact with a parent advocate (about to be established position at M.I.C.E.)

Reasons to TransitionReasons to Transition

• Families may transition from Monitoring Services to Direct Services when there is:– Parental request– Change in audiological/medical status– Diagnosis of potentially compounding

condition (s)– Physician request

Benefits Benefits

• Families more receptive to monitoring services

• Allows more time/ resources for infants and toddlers with more significant needs

• System allows for flexibility

• Will make modifications based on the results of an upcoming parent survey