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Guam Early Hearing Detection and Intervention
Project Riko’hi:Reducing Loss to Follow-Up after Failure to Pass Newborn Hearing Screening and at All Levels of the
Hearing Continuum
1st Quarterly Meeting, June 8, 2015
Welcome and Thank You for Coming
Agenda
• Sign In & Welcoming• Call Meeting to Order• Introduction of Members• Approval of Minutes• Rikohi: Goals and Objectives• New HRSA Grant • Open Discussion• Announcements and Next Meeting
Outcomes
After this meeting, Advisory members will have increased knowledge on the following:
• New EHDI Grant Goals (now AIMS) and Objectives (Sub-Aims) and progress to date;
• Provide feedback and recommendations
• Provide an update to the EHDI Quality Assurance for EHDI Services
• Follow-up on concerns from last meeting:
– 1. Status of referring infant back to physician when parents refuse early intervention services
– 2. Parents who refuse service to visit deaf and hard or hearing classroom
– 3. Flag physicians who have high risk factors to insure they return for follow-up appointments
– 4. Status of GEIS move
AIM 1
By March 31, 2017, Project Rikohi with participating birth site screeners will utilize specifically targeted and measurable interventions that are culturally and linguistically competent such as quality improvement methodologies in reducing the number of infants LTF/D who have not passed a newborn hearing screening examination prior to discharge from a birthing site to 1% or less
GMHA Initial Screening Totals
Oct Nov Dec
Total Births 197 224 243
TotalScreened
199 223 236
Total FIS 8 12 10
0
50
100
150
200
250
300
101% 97%
4%
99%
4% 5%
Sagua Mañågu Initial Screening Totals
Oct Nov Dec
Total Births 27 42 41
Total Screened 25 41 39
Total FIS 1 3 1
0
5
10
15
20
25
30
35
40
45
4%
93%
7%3%
98% 95%
Initial Screening Totals (GMHA and SMBC)
Oct Nov Dec
Total Births 224 266 284
Total Screened 224 264 275
Total FIS 9 15 11
0
50
100
150
200
250
300
100%
4%
99%
6%
97%
4%
AIM 2
By March 31, 2017, Project Rikohi with participating birth site screeners and early
intervention staff will utilize specifically targeted and measurable interventions that are culturally and linguistically competent
such as quality improvement methodologies in reducing the number of infants LTF/D
currently at 6% who did not pass the outpatient hearing screening by one month
of age to 4% or less.
Outpatient Rescreen
Oct Nov Dec
Total Needing Rescreen 8 12 10
Total Rescreened 5 12 6
Total Deceased 0 0 0
Total Relocating 1 0 2
Total Refuse Services 0 0 0
Total Pending 0 0 1
Total Lost to Follow Up 2 0 1
0
2
4
6
8
10
12
14
25% 10%0%
Outpatient Rescreen
Oct Nov Dec
Total Needing Rescreen 1 3 1
Total Rescreened 1 3 1
Total Deceased 0 0 0
Total Relocating 0 0 0
Total Refuse Services 0 0 0
Total Lost to Follow Up 0 0 0
0
0.5
1
1.5
2
2.5
3
3.5
Outpatient Rescreen Totals (Sagua Managu)
0%
AIM 3
By March 31, 2017, Project Rikohi with early intervention staff will continue to utilize
specifically targeted and measurable interventions that are culturally and
linguistically competent such as quality improvement methodologies in reducing the
number of infants LTF/D for diagnostic audiological evaluation by 3 months of age
from the aggregate 16% from 2011 to 2014 to 8% or less
DAE Data
TotalInfants
Referredfor DAE
TotalInfants
ReceivingDAE
TotalInfants
ReceivingDAE by 3months
Total withHearing
Loss
TotalRelocating
TotalRefusingServices
TotalPending
DAETotal LFU
Series1 6 6 6 2 0 0 0 0
0
1
2
3
4
5
6
7
Total Infants Referred for DAE (October - December2014)
0% 0%
AIM 4
By March 31, 2017, Project Rikohi, with the medical home and early intervention staff, will continue toutilize specifically targeted and measurable interventions that are culturally and linguistically competent in reducing the number of infants LTF/D who have high risk factors for late onset and progressive hearing loss who fail to return for rescreen by six months of age from the current level of 20% to 10% or less
High Risk Rescreen Data
Oct Nov Dec
Total Needing Rescreen 11 10 12
Total Rescreened 8 9 4
Total Deceased 0 0 0
Total Relocating 0 0 0
Total Refuse Services 2 0 4
Total Pending 1 0 0
Total Lost to Follow Up 0 1 4
0
2
4
6
8
10
12
14
0%
33%
10%
AIM 5
By March 31, 2017, Project Rikohi with early intervention staff will continue to
identify and utilize specifically targeted interventions such as CLC QI
methodologies to ensure Individualized Family Service Plan
(IFSP) are in place by six months of age for 100% of infant’s identified with
persistent and permanent hearing loss
Early Intervention Services – Data
Total with Hearing Loss Total with IFSPTotal with IFSP prior to 6
months
Series1 2 0 0
0
0.5
1
1.5
2
2.5
Percent of Infants with HL receiving IFSP prior to 6 Months of Age
0% 0%
MFI Area of Focus
MFI Group for each AIM
Model For Improvement
Strategies to
Decrease Lost
to Follow Up
Guam EHDI
Staff /
Advisory
Develop
Framework and
Measures for
New Strategies
Identify Individual to
Carry Out Strategy
& Site
Pre-Work
LS 1
P
S
A D
LS 3LS 2
Adapted from © 2001 Institute for Healthcare Improvement
P
S
A D
AP1 AP2
Casey Family Programs
The Guam EHDI
Adapted BSC Process for Reducing Loss to Follow Up
Effective Strategy – Becomes
part of Guam EHDI SOPs
What are we trying toaccomplish?
How will we know that achange is an improvement?
What change can we make thatwill result in improvement?
Model for Improvement
Act Plan
Study Do
Adapted from © 2001 Institute for Healthcare Improvement
Goal Four
Training and Activities
EVENT (NOVEMBER 2014-MARCH2015) RESULTS
Prenatal classes GMH & SM 207 participants
Outreach activities 709 brochures/resources
Trainings 10 Nurses on correct use of hearing screening equipment
Hearing Screening 51 children/5 referred to GEIS & 3 referred to Preschool for follow-up
Media Development
200 Early Childhood Informational Videos featuring Parent Testimonials on early hearing detection being disseminated to new parents via Nene Bags.
• Guam Early Hearing Detection & Intervention Program
• Guam Early Intervention System - Ask your Doctor
• The First 2,000 Days
• What Parents are saying about Early Intervention System
• Guam Early Intervention System - Parent Testimonial
• The Importance of Early Intervention
• Kariñu Project
• Kariñu: Loving Our Babies
• Guam Early Intervention System - Developmental Screener
• Gross Motor is Not Gross
• Life is Good Playmakers
Open Discussion
