The Status of Early Hearing Detection and Intervention in the United States

The Status of Early Hearing Detection and Intervention in the United States

Blindness separates people from things.Deafness separates people from people.

--- Helen Keller

Improvements in Hearing Screening Equipment

Number of Hospitals Doing Universal Newborn Hearing Screening

3 3 11 26 60 120 243462

712934

2050

-100100300500700900

110013001500170019002100

Num

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Endorsements for Universal Newborn Screening

• National Institutes of Health• American Academy of Pediatrics• Maternal and Child Health Bureau• Centers for Disease Control &

Prevention• Joint Committee on Infant Hearing• American Academy of Audiology• American Speech-Language-Hearing

Association• National Association of the Deaf

Why is Early Identification of Hearing Loss so Important?

• Hearing loss is the most frequent birth defect.

Rate Per 1000 of Permanent Childhood Hearing Loss in UNHS Programs

Sample PrevalenceSite Size Per 1000

Rhode Island (3/93 - 6/94) 16,395 1.71

Colorado (1/92 - 12/96) 41,976 2.56

New York (1/95 - 12/97) 69,761 1.95

Texas (1/94 - 6/97) 52,508 2.15

Hawaii (1/96 - 12/96) 9,605 4.15

New Jersey (1/93 - 12/95) 15,749 3.30

Incidence per 10,000 of Congenital Defects/Diseases

30

12 116 5

2 1

0

10

20

30

40

Hearing Loss

Cleft lip or palate

Down Syndrome

Limb defects

Spina bifida

Sickle Cell Anemia

PKU

Why is Early Identification of Hearing Loss so Important?

• Hearing loss is the most frequent birth defect.

• Undetected hearing loss has serious negative consequences.

Reading Comprehension Scores of Hearing and Deaf Students

1.02.03.04.05.06.07.08.09.0

10.0

8 9 10 11 12 13 14 15 16 17 18

DeafHearing

Age in Years

Schildroth, A. N., & Karchmer, M. A. (1986). Deaf children in America, San Diego: College Hill Press.

Gra

de E

quiv

alen

ts

Effects of Unilateral Hearing Loss

MathLanguage

MathLanguage

Social

MathLanguage

MathLanguage

Social0th 10th 20th 30th 40th 50th 60th

Percentile Rank

Normal Hearing Unilateral Hearing Loss

Keller & Bundy (1980)(n = 26; age = 12 yrs)

Peterson (1981)(n = 48; age = 7.5 yrs)

Bess & Thorpe (1984)(n = 50; age = 10 yrs)

Blair, Peterson & Viehweg (1985) (n = 16; age = 7.5 yrs)

Culbertson & Gilbert (1986)(n = 50; age = 10 yrs)

Average ResultsMath = 30th percentile

Language = 25th percentileSocial = 32nd percentile

Why is Early Identification of Hearing Loss so Important?

• Hearing loss is the most frequent birth defect.

• Undetected hearing loss has serious negative consequences.

• There are dramatic benefits associated with early identification of hearing loss.

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)

Lang

uage

Age

(yrs

)Boys Town National Research Hospital Study of Earlier vs. Later

Moeller, M.P. (1997). Personal communication, moeller@boystown.org

129 deaf and hard-of-hearing children assessed 2x each year.

Assessments done by trained diagnostician as normal part of early intervention program.

Tremendous ProgressDuring the Last Decade

• Less than 30 hospitals with UNHS in 1993; compared with more than 2000 today

• More than 2 million babies are screened every year prior to discharge

• 34 states have passed legislation related to newborn hearing screening

The Other Side of the Coin . . . .

• 2,200 hospitals are not yet screening for hearing loss

• Almost 2 million babies are NOT screened every year prior to discharge

• Existing legislation is of variable quality

• Only 9 states (accounting for 7% of the births) have implemented reasonable statewide programs

• Follow-up rates are often alarmingly low

• Some hospitals have unacceptably high referral rates

Good work,but I think we mightneed just a little more detail righthere.

Implementing Effective EHDI Programs

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Start

Status of EHDI Programs in the United States

• Universal Newborn Hearing Screening

• Effective Tracking and Follow-up as a part of the Public Health System

• Appropriate and Timely Diagnosis of the Hearing Loss

• Prompt Enrollment in Appropriate Early Intervention

• A Medical Home for all Newborns

• Culturally Competent Family Support

• Elimination of geographic and financial barriers to service access

Goal of Workshop• As a result of this workshop,

participants will:

– Develop a plan for implementing an effective statewide UNSHI program

– Outline the contents of the grant application to be submitted June 15th

– Understand how grant applications will be reviewed so that critical components can be included

Resources are available to helpwww.infanthearing.org