Early Hearing Detection: Collaboration and Outcomes

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

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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, moeller@boystown.org

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

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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

carroltp@dhec.sc.gov