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New York State New York State Department of HealthDepartment of Health
Outcomes of New York’s Outcomes of New York’s Newborn Hearing Screening Program Newborn Hearing Screening Program
Lynn Spivak, Ph.D., CCC-ALynn Spivak, Ph.D., CCC-AConnie Donohue, M.A., CCC-AConnie Donohue, M.A., CCC-A
NIH Consensus ConferenceNIH Consensus ConferenceMarch 1-3, 1993March 1-3, 1993
All newborns should be screened for All newborns should be screened for hearing loss (not just high risk).hearing loss (not just high risk).
Recommended method:Recommended method:– 2 Stage Screen consisting of OAE & ABR2 Stage Screen consisting of OAE & ABR
New York State Demonstration ProjectNew York State Demonstration Project
1995 – 19981995 – 1998
Purpose: Determine Purpose: Determine the feasibility and the feasibility and
cost effectiveness of cost effectiveness of NBHS in NY State.NBHS in NY State.
NYS Demonstration ProjectNYS Demonstration Project
7 Hospitals from different regions:7 Hospitals from different regions:– New York CityNew York City– UpstateUpstate– Long IslandLong Island
TEOAE + ABRTEOAE + ABR Tested 69,766 newborns (97% of births)Tested 69,766 newborns (97% of births)
The Learning Curve: Refer Rates The Learning Curve: Refer Rates (Fails & Misses)(Fails & Misses)
0
1
2
3
4
5
6
7
Year 1 Year 2 Year 3
% % Failed% Missed
NYS Demonstration ProjectNYS Demonstration ProjectFollow-upFollow-up
NICUNICU WBNWBN TOTALTOTAL
% Fails % Fails ReturnedReturned
80%80% 70%70% 72%72%
% Missed% Missed
ReturnedReturned
34%34% 27%27% 31%31%
NYS Demonstration ProjectNYS Demonstration ProjectFollow-Up Improvement with TimeFollow-Up Improvement with Time
0
10
20
30
40
50
60
70
80
90
Year 1 Year 2 Year 3
Perc
ent
Retu
rned
% Fail% Miss
NYS Demonstration ProjectNYS Demonstration ProjectPrevalence of Hearing LossPrevalence of Hearing Loss
Overall Overall 1.96 / 10001.96 / 1000 AdjustedAdjusted 2.80 / 10002.80 / 1000
NICUNICU 8.00 / 10008.00 / 1000 WBNWBN 0.90 / 10000.90 / 1000
NYS Demonstration ProjectNYS Demonstration Project
COSTCOST
$30 per infant screened$30 per infant screened
Newborn Hearing Screening in Newborn Hearing Screening in New York New York
Review of StatuteReview of Statute
– Chapter 585 of the Laws of 1999Chapter 585 of the Laws of 1999
– Requires the commissioner of health to Requires the commissioner of health to establish a program to screen newborn infants establish a program to screen newborn infants for hearing problemsfor hearing problems
UNHS: NYS LegislationUNHS: NYS Legislation The commissioner shall--establish a The commissioner shall--establish a
program to screen newborn infants for program to screen newborn infants for hearing problemshearing problems
Incorporate consensus medical guidelinesIncorporate consensus medical guidelines– most cost effective methods for detecting HL as most cost effective methods for detecting HL as
early as possibleearly as possible Program shall provide for follow-upProgram shall provide for follow-up
UNHS: NYS LegislationUNHS: NYS Legislation Program shall provide for reimbursement of Program shall provide for reimbursement of
health care providers performing screeninghealth care providers performing screening
Hospitals must administer program or Hospitals must administer program or provide a referral for outpatient screeningprovide a referral for outpatient screening
UNHS: Ad Hoc Advisory UNHS: Ad Hoc Advisory CommitteeCommittee
2 Pediatricians2 Pediatricians 2 Audiologists2 Audiologists 2 Lawyers2 Lawyers
– representing hospital organizationsrepresenting hospital organizations 2 Parents2 Parents 1 Rep from Rural Hospitals1 Rep from Rural Hospitals 1 State Insurance Department Rep1 State Insurance Department Rep Representatives from DOHRepresentatives from DOH
UNHS: NYS LegislationUNHS: NYS Legislation
Regulations adopted—August 22, 2001Regulations adopted—August 22, 2001 Regulations went into effect October 20Regulations went into effect October 20 thth, ,
20012001
Required Program Components Required Program Components
Conduct inpatient screeningConduct inpatient screening Communication of results to parentsCommunication of results to parents Conduct follow-up screen or referral Conduct follow-up screen or referral
– failsfails– missesmisses
Referral of infants suspected of having Referral of infants suspected of having hearing loss to the Early Intervention hearing loss to the Early Intervention Program (EIP)Program (EIP)
Required Components (2)Required Components (2)
Designate program managerDesignate program manager Provide supervision & training of screenersProvide supervision & training of screeners Maintain & calibrate equipmentMaintain & calibrate equipment Provide adequate space for screeningProvide adequate space for screening Report aggregate data to DOHReport aggregate data to DOH Establish QA protocolsEstablish QA protocols
EquipmentEquipment
Fully automatedFully automated
No clinical decision making requiredNo clinical decision making required
– ALGOALGO
– EchocheckEchocheck
DocumentationDocumentation
Inpatient screening resultsInpatient screening results Outpatient screening results known to Outpatient screening results known to
facilityfacility Referrals to EIPReferrals to EIP Issuance of prescription for infants who fail Issuance of prescription for infants who fail
or were missedor were missed
Parent Notification/EducationParent Notification/Education
Brochures supplied by DOH Brochures supplied by DOH » Information for ParentsInformation for Parents
» Your Baby Passed Your Baby Passed
» Your Baby Needs Another ScreeningYour Baby Needs Another Screening
» How to Get Your Baby’s Hearing ScreenedHow to Get Your Baby’s Hearing Screened
– Communication milestonesCommunication milestones– Signs of hearing lossSigns of hearing loss
Inform parents of screen results before Inform parents of screen results before dischargedischarge
Early Hearing Detection and Early Hearing Detection and Intervention ProgramsIntervention Programs
Early Hearing Detection and Intervention Early Hearing Detection and Intervention (EHDI) Programs(EHDI) ProgramsNewborn hearing screening is one component Newborn hearing screening is one component
of EHDI Programsof EHDI ProgramsAmerican Academy of Pediatrics Task Force American Academy of Pediatrics Task Force
Components of EHDI Programs Components of EHDI Programs in the USin the US
Universal newborn hearing screeningUniversal newborn hearing screening Effective tracking and follow-up Effective tracking and follow-up Appropriate and timely diagnosis of the hearing lossAppropriate and timely diagnosis of the hearing loss Prompt enrollment in appropriate early interventionPrompt enrollment in appropriate early intervention A medical home for all newbornsA medical home for all newborns Culturally competent family supportCulturally competent family support Elimination of barriers to service accessElimination of barriers to service access
Healthy People 2010Healthy People 2010
Objective 28-11:Objective 28-11:
Increase the proportion of newborns who Increase the proportion of newborns who are screened for hearing loss by age 1 are screened for hearing loss by age 1 month, have audiologic evaluation by age 3 month, have audiologic evaluation by age 3 months, and are enrolled in appropriate months, and are enrolled in appropriate intervention services by age 6 months.intervention services by age 6 months.
EHDI TimelineEHDI Timeline
Before One Month of AgeBefore One Month of Age– Outpatient re-screening for all failed or missed Outpatient re-screening for all failed or missed
screeningsscreenings Before Three Months of Age:Before Three Months of Age:
– Referral of infants that do not pass an initial Referral of infants that do not pass an initial (inpatient) screening and an outpatient re-(inpatient) screening and an outpatient re-screening to the Early Intervention Program screening to the Early Intervention Program
– Audiological evaluationAudiological evaluation
EHDI Timeline (2)EHDI Timeline (2)
Before Three Months of AgeBefore Three Months of AgeIf Hearing Loss is ConfirmedIf Hearing Loss is Confirmed– Early intervention servicesEarly intervention services– Parental information and choices about Parental information and choices about
amplification and communication optionsamplification and communication options Before Six Months of AgeBefore Six Months of Age
– Continue early interventionContinue early intervention– Additional consultation as neededAdditional consultation as needed
Newborn Hearing ScreeningNewborn Hearing Screening in New York in New York
Highlights of program developmentHighlights of program development– Funding in 2002 Governor’s budgetFunding in 2002 Governor’s budget– Guidance memorandumGuidance memorandum– Ongoing technical assistanceOngoing technical assistance– Screening ratesScreening rates
Hospital Newborn Hearing Hospital Newborn Hearing Screening ProgramsScreening Programs
Options for administering programsOptions for administering programs– Screen infants prior to discharge and conduct Screen infants prior to discharge and conduct
outpatient re-screens for infants who referoutpatient re-screens for infants who refer– Screen infants prior to discharge and refer Screen infants prior to discharge and refer
infants who do not pass to a different facility infants who do not pass to a different facility for outpatient re-screenfor outpatient re-screen
– Refer all infants for hearing screening after Refer all infants for hearing screening after discharge (facilities with 400 or fewer births discharge (facilities with 400 or fewer births per year)per year)
Newborn Hearing Screening Newborn Hearing Screening Data Reporting RequirementsData Reporting Requirements
All maternity hospitals and birthing centers All maternity hospitals and birthing centers submit quarterly reports to the Department submit quarterly reports to the Department of Healthof Health– Aggregate dataAggregate data– Due 90 days after the close of the quarterDue 90 days after the close of the quarter
Data Reporting: Data PointsData Reporting: Data Points
Number of inpatient screens conductedNumber of inpatient screens conducted» (pass, fail)(pass, fail)
Number of missed inpatient screensNumber of missed inpatient screens Number of outpatient screens conductedNumber of outpatient screens conducted
» (pass, fail)(pass, fail)
Number of refusalsNumber of refusals
Date Reporting: Data DictionaryDate Reporting: Data Dictionary
Inpatient Initial Screening Final ResultInpatient Initial Screening Final Result» Passed: Number of infants who passed on first Passed: Number of infants who passed on first
screen or following subsequent screening prior to screen or following subsequent screening prior to dischargedischarge
» Failed – Unilateral: Number of infants who did not Failed – Unilateral: Number of infants who did not pass the hearing screening in one ear prior to pass the hearing screening in one ear prior to dischargedischarge
» Failed – Bilateral: Number of infants who did not Failed – Bilateral: Number of infants who did not pass the hearing screening in both ears prior to pass the hearing screening in both ears prior to dischargedischarge
» Refused: Number of infants for whom the guardian Refused: Number of infants for whom the guardian declined inpatient screeningdeclined inpatient screening
Data Reporting: Data Points (2)Data Reporting: Data Points (2)
Number of referrals for outpatient screeningNumber of referrals for outpatient screening Number of results returned to the facility by Number of results returned to the facility by
other providers conducting outpatient other providers conducting outpatient screensscreens– (pass, fail)(pass, fail)
Number of at-risk infants referred to the Number of at-risk infants referred to the Early Intervention Program for follow-upEarly Intervention Program for follow-up
Data Reporting: Data DictionaryData Reporting: Data Dictionary
Number of Newborns Receiving Outpatient Number of Newborns Receiving Outpatient Hearing Screenings for Births in Reporting Hearing Screenings for Births in Reporting PeriodPeriod
» Referred: Missed Initial: Applicable to infants Referred: Missed Initial: Applicable to infants issued prescriptions for outpatient newborn hearing issued prescriptions for outpatient newborn hearing screening due to being missed during inpatient stayscreening due to being missed during inpatient stay
» Referred: Failed Initial: Applicable to infants who Referred: Failed Initial: Applicable to infants who were issued prescriptions for newborn hearing were issued prescriptions for newborn hearing screening due to failing initial inpatient screeningscreening due to failing initial inpatient screening
Data Reporting: Data Points (3)Data Reporting: Data Points (3)
Number of Newborns for Reporting Period Number of Newborns for Reporting Period with a Failed Initial Screen and No Re-with a Failed Initial Screen and No Re-screening Results Returned to the Facilityscreening Results Returned to the Facility– Fewer than 75 days post dischargeFewer than 75 days post discharge– 75 days or greater post discharge75 days or greater post discharge
» Referred to early interventionReferred to early intervention
» Not referred to early intervention due to parental Not referred to early intervention due to parental objectionobjection
» Lost to follow-upLost to follow-up
Newborn Hearing Screening Newborn Hearing Screening Progress in New YorkProgress in New York
Babies screened for hearing loss prior to Babies screened for hearing loss prior to hospital dischargehospital discharge
– October – December 2001: 85%October – December 2001: 85%– January – December 2002: 96.44%January – December 2002: 96.44%– January – December 2003: 98.6%*January – December 2003: 98.6%*
*based on newborn hearing screening data*based on newborn hearing screening data
Newborn Hearing Screening Newborn Hearing Screening Progress in New YorkProgress in New York
2003 Statistics2003 Statistics– Number of babies screened: 230,139Number of babies screened: 230,139– Refer rate: 4.2%Refer rate: 4.2%– Percentage of babies receiving a re-screen: Percentage of babies receiving a re-screen:
73.2% 73.2% – Percentage of babies with suspected hearing Percentage of babies with suspected hearing
loss: 0.51%loss: 0.51%– Referrals to early intervention: 308Referrals to early intervention: 308
Children With a Diagnosis Upon Children With a Diagnosis Upon Referral to the EIPReferral to the EIP
Children Referred to EI with a Children Referred to EI with a Diagnosis of Hearing LossDiagnosis of Hearing Loss
Children Referred to EI with a Children Referred to EI with a Diagnosis of Hearing Loss Diagnosis of Hearing Loss
Early Intervention Guidance Early Intervention Guidance Memorandum 2003-03Memorandum 2003-03
Newborn Hearing ScreeningNewborn Hearing Screening– General informationGeneral information– Role of maternity hospitalsRole of maternity hospitals– Role of the Early Intervention Program Role of the Early Intervention Program
» Referral processReferral process
» Procedural aspectsProcedural aspects
» Early intervention servicesEarly intervention services
Referral to Early Intervention Referral to Early Intervention
Following newborn hearing screeningFollowing newborn hearing screening
1.1. After an infant fails two hearing After an infant fails two hearing screenings screenings
2.2. When an infant fails initial hearing When an infant fails initial hearing screening and does not receive a follow-screening and does not receive a follow-up screening within 75 days after up screening within 75 days after dischargedischarge
Referral to Early InterventionReferral to Early Intervention
Children are referred to the Early Children are referred to the Early Intervention Official in their county of Intervention Official in their county of residenceresidence– Primary referral sources must refer children Primary referral sources must refer children
under age three with suspected or confirmed under age three with suspected or confirmed developmental delay or disability to the Early developmental delay or disability to the Early Intervention Official unless the parent objectsIntervention Official unless the parent objects
Early InterventionEarly Intervention
Part C of IDEA is an important resource for Part C of IDEA is an important resource for infants with hearing loss and their familiesinfants with hearing loss and their families– Audiology services are included in Early Audiology services are included in Early
Intervention Program regulations Intervention Program regulations (10 NYCRR Section 69-4.1(k)(2)(iii)(a-f))(10 NYCRR Section 69-4.1(k)(2)(iii)(a-f))
Considerations for Early Considerations for Early InterventionIntervention
For children with hearing loss and their For children with hearing loss and their families...families...– Family SupportFamily Support
– Technology DecisionsTechnology Decisions
– Communication ChoicesCommunication Choices
Other ResourcesOther Resources
National Center for Hearing Assessment and Management National Center for Hearing Assessment and Management (NCHAM)(NCHAM)– Web site: Web site: www.infanthearing.orgwww.infanthearing.org
American Speech-Language-Hearing Association (ASHA)American Speech-Language-Hearing Association (ASHA)– Web site: Web site: www.asha.orgwww.asha.org
New York State Department of HealthNew York State Department of Health– Web site: Web site: http://www.health.state.ny.ushttp://www.health.state.ny.us
» Family & Community Health, Infants & Children, Family & Community Health, Infants & Children, Early InterventionEarly Intervention
Good work,but I think we mightneed just a little more detail righthere.
Implementing Effective Screening Programs
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