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Centers for Disease Control and Prevention

National Center on Birth Defectsand Developmental Disabilities

Division of Human Development and Disability

Centers for Disease Control and Prevention

National Center on Birth Defectsand Developmental Disabilities

Division of Human Development and Disability

Military Audiology AssociationFebruary 13, 2006

Military Audiology AssociationFebruary 13, 2006

John Eichwald, Team LeadJohn Eichwald, Team Lead

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Congenital Defects/DiseasesIncidence per 10,000Incidence per 10,000

25

13.6 13.1

8.3

4.22.5

0

10

20

30

MACDP NCBDDD 2004

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Conditions Screened in the Newborn Conditions Screened in the Newborn Incidence per 10,000Incidence per 10,000

25

42.2 1.9

0.7 0.5 0.10

10

20

30

NNSGRC 2003

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Reading Comprehension Scores of Hearing and Deaf Students

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0

8 9 10 11 12 13 14 15 16 17 18

Deaf

Hearing

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

Gra

de

Eq

uiv

alen

ts

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Study of Early versus Late IdentificationStudy of Early versus Late Identification

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)

Moeller, M.P. (1997). Boys Town National Research Hospital

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

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

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Universal Newborn Hearing Screening Endorsement

Universal Newborn Hearing Screening Endorsement

• American Academy of Audiology (AAA)• American Academy of Pediatrics (AAP)• American Speech-Language-Hearing Association

(ASHA)• Centers for Disease Control and Prevention (CDC)• Joint Committee on Infant Hearing (JCIH)• Maternal and Child Health Bureau (MCHB)• National Association of the Deaf (NAD)• National Institutes of Health (NIH)

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CDC EHDI Vision and MissionCDC EHDI Vision and MissionCDC EHDI Vision and MissionCDC EHDI Vision and Mission

• The vision of the Early Hearing Detection The vision of the Early Hearing Detection and Intervention (EHDI) program is to and Intervention (EHDI) program is to promote communication from birth for all promote communication from birth for all children.children.

• The mission of EHDI is for every state and The mission of EHDI is for every state and territory to have a complete EHDI tracking territory to have a complete EHDI tracking and surveillance system that ensures and surveillance system that ensures children with hearing loss achieve children with hearing loss achieve communication and social skills communication and social skills commensurate with their cognitive abilities. commensurate with their cognitive abilities.

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Children’s Health Act of 2000Public Law 106–310

Children’s Health Act of 2000Public Law 106–310

DIVISION A—CHILDREN’S HEALTH

TITLE VII—EARLY DETECTION, DIAGNOSIS, AND TREATMENT REGARDING HEARING LOSS IN INFANTS

The purposes of this title are to clarify the authority within the Public Health Service Act to authorize statewide newborn and infant hearing screening, evaluation and intervention programs and systems, technical assistance, a national applied research program, and interagency and private sector collaboration for policy development, in order to assist the States in making progress toward the following goals:

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Children’s Health Act of 2000Public Law 106–310

Children’s Health Act of 2000Public Law 106–310

(1) All babies born in hospitals in the United States and its territories should have a hearing screening before leaving the birthing facility.

(2) All babies who are not born in hospitals in the United States and its territories should have a hearing screening within the first 3 months of life.

(3) Appropriate audiologic and medical evaluations should be conducted by 3 months for all newborns and infants suspected of having hearing loss to allow appropriate referral and provisions for audiologic rehabilitation, medical and early intervention before the age of 6 months.

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Children’s Health Act of 2000Public Law 106–310

Children’s Health Act of 2000Public Law 106–310

(4) All newborn and infant hearing screening programs and systems should include a component for audiologic rehabilitation, medical and early intervention options that ensures linkage to any new and existing state-wide systems of intervention and rehabilitative services for newborns and infants with hearing loss.

(5) Public policy in regard to newborn and infant hearing screening and intervention should be based on applied research and the recognition that newborns, infants, toddlers, and children who are deaf or hard-of-hearing have unique language, learning, and communication needs, and should be the result of consultation with pertinent public and private sectors.

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Children’s Health Act of 2000Children’s Health Act of 2000

DIVISION A — CHILDREN’S HEALTHDIVISION A — CHILDREN’S HEALTH

TITLE VII — EARLY DETECTION, DIAGNOSIS, AND TITLE VII — EARLY DETECTION, DIAGNOSIS, AND TREATMENT REGARDING HEARING LOSS IN TREATMENT REGARDING HEARING LOSS IN INFANTSINFANTS

Health Resources and Services Administration (HRSA) shall:

make awards of grants or cooperative agreements to develop statewide newborn and infant hearing screening, evaluation and intervention programs and systems

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Children’s Health Act of 2000Children’s Health Act of 2000

The Centers for Disease Control and Prevention shall:• develop standardized procedures for data management• provide technical assistance on data collection and

management • promote the sharing of data regarding early hearing loss

with state-based birth defects and developmental disabilities monitoring programs

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Children’s Health Act of 2000Children’s Health Act of 2000

The Centers for Disease Control and Prevention (CDC) shall:

develop standardized procedures for data management and program effectiveness and costs, such as to:

• ensure quality monitoring of newborn and infant hearing loss screening, evaluation, and intervention programs and systems;

• provide technical assistance on data collection and management;

• to study the costs and effectiveness of newborn and infant hearing screening, evaluation and intervention programs and systems conducted by State-based programs in order to answer issues of importance to State and national policymakers;

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Children’s Health Act of 2000Children’s Health Act of 2000

National Institutes of Health (NIH) shall:

continue a program of research and development on the efficacy of new screening techniques and technology, including clinical studies of screening methods, studies on efficacy of intervention, and related research.

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WA 81%

MT 97%

OR 95%

NV99%

CA 56%

UT 98%

AZNM 92%

CO 97%

ID 83%

WY 98%

ND 95%

SD 90%

MN 93%

IA NE 97%

KS 97%

TX 97%

FL86%

MS95%

LA94%

GA 96%

SC 98%

NC 96%

VA96%

ME 94%

NY 92%

WI 93%

OK 96%

MO 99%

AR 92%TN 97%

KY 99%

IL100%

IN 99%

MI*

OH40%

WV98% MD 91%

DE 83%NJ 98%

VT 93%

RI 99%

CT 97%

NH 91%

MA 99%

AK 81%

HI 99%

PA 98%

87.2% Newborns Screened (2003)(n = 47)

87.2% Newborns Screened (2003)(n = 47)

>90% HP 2010 28-11 Target

>65% HP 2010 28-11 Baseline

<65%

Not Reported

AL96%

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WA

MT*

OR 35%

NV

CA80%

UT 66%

AZNM

CO89%

ID 100%

WY 94%

ND43%

SD69%

MN53%

IA NE 82%

KS 77%

TX

FL

MS84%

LA65%

AL GA14%

SC 65%

NC*

VA70%

ME

NY25%

WI

OK 32%

MO 20%

AR 47%TN 61%

KY 14%

IL77%

IN

MI*

OH17%

WV66% MD 27%

DE 100%NJ 53%

VT86%

RI 95%

CT 73%

NH 9%

MA 85%

AK

HI 74%

PA60%

55.9% Audiological Evaluation (2003)(n = 35)

55.9% Audiological Evaluation (2003)(n = 35)

>70% HP 2010 28-11 Target

>55% HP 2010 28-11 Baseline

<55%

Not Reported

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WA

MT*

OR 39%

NV

CA87%

UT 41%

AZ NM50%

CO 45%

ID 100%

WY 100%

ND

SD100%

MN100%

IA NE 67%

KS 84%

TX

FL

MS85%

LA53%

AL GA

SC*

NC

VA63%

ME

NY61%

WI

OK 91%

MO 52%

AR 64%TN 100%

KY 100%

IL29%

IN67%

MI*

OH28%

WV75% MD

DE 100%NJ 75%

VT0%

RI 100%

CT 100%

NH 64%

MA 71%

AK 0%

HI 83%

PA64%

67.3% Intervention by 6 months (2003)(n = 34)

67.3% Intervention by 6 months (2003)(n = 34)

>90% HP 2010 28-11 Target

>65% HP 2010 28-11 Baseline

<65%

Not Reported

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Births: Combined US Military ForcesBirths: Combined US Military Forces

• Approximately 95,000 military families each year - more individual births than all but the 12 largest states

• Approximately 40% of these births occur at military facilities

• Military births take place in all 50 states and more than 20 foreign countries (8.5%)

• More than 2,000 military births per year occur in each of 11 states:– CA, CO, FL, GA, HI, KY, MD, NC, TX, VA, and WA

Non-US sites:– Germany and Japan (both > 2,000)– 3,700 in other sites

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Hawaii

Puerto Rico

Military Hospitals Military Hospitals

Guam

Air ForceArmyNavy

Air ForceArmyNavy

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Recent CDC EHDI ActivitiesRecent CDC EHDI Activities

• DoD Birth and Infant Health Registry (BIHR)DoD Birth and Infant Health Registry (BIHR)

05 Jan 06

• telephone call with LCDR Margaret Ryan, M.D.

(Navy) Director, DoD Center for Deployment Health

Research and Christina Spooner, M.S., coordinator

for the BIHR

– Surveillance for birth defects in partnership with

CDC’s National Birth Defects Prevention Network

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DoD Birth and Infant Health RegistryDoD Birth and Infant Health Registry

• Preliminary BIHR results suggest a steady increase in

the use of V72.1 (examination of ears and hearing)

since 1998 with a large increase in the year 2000

– Increase in services or reporting?

• Approximately 1/3 of reported military births had this

code associated with their obtained services in 2003

• BIHR will continue to explore codes in their data set

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11 Jan 06 Teleconference11 Jan 06 Teleconference

ArmyArmy (Walter Reed): Donna MacNeil, M.A., FAAA

Air ForceAir Force: CPT Alicia Burke, M.A.

NavyNavy: CDR Leslie Sims, M.S., FAAA

CDR Margaret Ryan, M.D.

CDR Michelle Gasper, M.D.

CPT Martin McCaffrey, M.D.

LT Anne Jarrett, M.A. CCC-A

Christina Spooner, M.S.

BUMEDBUMED (D.C.) CDR Khin Aungthein, RNC, MSN

CDCCDC: John Eichwald, M.A., FAAA

Craig Mason, Ph.D.

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Teleconference Issues IdentifiedTeleconference Issues Identified• Most military programs are felt to be reporting data to their

respective state EHDI program• There is no uniform reporting of EHDI data or centralized

database for military families• Audiologists are generally responsible for follow-up

newborns who fail the initial screen• Primary Care Manager (PCM) responsible for follow-up

when no audiologist is assigned to a facility• Good early intervention support system available through

Educational and Developmental Intervention Services (EDIS) both domestically and overseas

• EHDI services spread out in particular for non US sites

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CDC / NCBDDD / EHDI Briefing CDC / NCBDDD / EHDI Briefing

06 Feb 06• RADM José Cordero, MD, MPH, FAAP

– Director, CDC National Center on Birth Defects and Developmental Disabilities

– Assistant Surgeon General• Peter Rzeszotarski, MA

– Acting Associate Director for Policy, Planning, and Evaluation

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Future ActivitiesFuture Activities• Continue communication among CDC-EHDI

and all military branches• Development of a new audiology survey for all

branches (Dr. McCaffrey and Dr. Ryan expressed interest in collaborating on the survey)

• Teleconference with the EDIS Program Manager

• Possible EHDI Special Topics Teleconference concerning EHDI and the Military

• Offer of resources, materials and training

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American Academy of Pediatrics PediaLinkAmerican Academy of Pediatrics PediaLink

• Web-based educational program for pediatric health care professionals

• Modules:

– different types of hearing loss

– screening methods for hearing loss

– medical and genetic risk factors

– the importance of early recognition and ongoing surveillance

– the role of the medical home in hearing screening

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American Academy of Pediatrics PediaLinkAmerican Academy of Pediatrics PediaLink

• CDC-EHDI Free Scholarships for Continuing Medical Education

(5 AMA PRA Category 1 credits)• Contact:

– John Eichwald: ‘jeichwald@cdc.gojeichwald@cdc.gov’ – Jill Ackermann: ‘JAckermann@aap.orgJAckermann@aap.org– or: screening@aap.org screening@aap.org’

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Questions?Questions?

The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.

jeichwald@cdc.gov