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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     Incidence Per 10,000 Births

      30
      25
      20
      15
      10
       5
       0
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……
Boys Town National Research Hospital Study of Earlier vs. Later
                        6

                        5         Identified <6 mos (n = 25)
   Language Age (yrs)




                                  Identified >6 mos (n = 104)
                        4

                        3

                        2

                        1

                        0
                            0.8      1.2        1.8       2.2       2.8       3.2       3.8    4.2   4.8
                                                             Age (yrs)
                            Moeller, M.P. (1997).Personal communication moeller@boystown.org
                                                                      ,
Why Do Newborn Hearing Screening……
                        Vocabulary Size for Hearing Impaired Children
                          Identified Before and After 6 Months of Age
                  300
                        Identified BEFORE 6 Months
                  250
Vocabulary Size




                        Identified AFTER 6 Months
                  200

                  150

                  100

                  50

                   0
                        13-18 mos        19-24 mos     25-30 mos     31-36 mos
                        (n = 15/8)       (n = 12/16)   (n = 11/20)   (n = 8/19)
                                     Chronological Age in Months
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                             Reporting &
      All babies referred by hospital
       screening are to receive:          Monitoring
         Audiologic Evaluation by          NBHS reporting
          Audiologist, or
                                             procedures must be
         Medical Evaluation by
          Physician or                       followed by:
          Otolaryngologist, or                Hospitals
         Both if indicated
                                              Audiologists
      Confirmed HL:
        Medical Intervention                 Early Interventionists
        Audiologic Habilitation
        Early Intervention services
        Augmentative Hearing Devices
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
                                                                           Refer to
                                                                           BabyNet

Hospital             Referred to             Audiology
 Hearing     Fail   Audiologist for   Fail   Diagnostic   CHL             Habilitation
Screening             Re-Screen              Evaluation                      Recs



  Pass                                                                      Hearing
                         Pass                 Normal                         Aids
                                                                              CI
                                                                             Sign
Literature                                                                   Lang
                      Literature             Literature


                                                                 Parent
                                                                Support
DATA COLLECTION

 HOSPITALS                       AUDIOLOGISTS
  Started with paper data          Started with paper data
   collection                        collection
  ~ 2003 began electronic          ~ 2003 began electronic
   data collection                   data collection
  April 1, 2008 data               Report results of any
   collection process                newborn referred by
   integrated with Vital             hospital for follow up
   Records
  Report screening results on
   every baby
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?

                          Screening Rate
100%                                 99%
                               98%
98%                97%   97%               97%   97%   97%
                                                             96% 96%
96%    95%

94%          93%

92%

90%
       AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
How Are We Doing?

                      Confirmed HL
120
           106
100
                 85                       82
      74                     77      75
80                      68
                                               62   58
60
                                                         40
40

20

 0
      2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
How Are We Doing?

                           EI by 6 mos old
120%
       100%
100%                      88%
80%
                    63%                           60%
                                      58%
60%           51%                           49%         53%
                                                              43%
                                38%
40%

 20%

 0%
       AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
How Are We Doing?

               Lost to Follow-Up/Documentation
50%
                    43%
40%          38%                                       37%
                                                32%           33%
      29%
30%
                           21%    23%    23%
20%

10%

 0%
      2003   2004   2005   2006   2007   2008   2009   2010   2011
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



            Verification
            of Screening                                Report
               Results                                Diagnostic
                                                       Results




                                             Report Need
                     Audiology
                                              for Further
                     Resource
                                               Follow Up
FIRST SOUND


               Questions?


          Tara Carroll, MCD, CCC/A
    First Sound Program Manager/Audiologist
                 803-898-0708
             carroltp@dhec.sc.gov

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Early Hearing Detection: Collaboration and Outcomes

  • 1. Early Hearing Detection and Intervention: Opportunities for Collaboration to Impact Outcomes
  • 2. Why Do Newborn Hearing Screening……  Hearing loss is the most frequent occurring birth defect Incidence Per 10,000 Births 30 25 20 15 10 5 0
  • 3. 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.
  • 4. Why Do Newborn Hearing Screening…… Boys Town National Research Hospital Study of Earlier vs. Later 6 5 Identified <6 mos (n = 25) Language Age (yrs) Identified >6 mos (n = 104) 4 3 2 1 0 0.8 1.2 1.8 2.2 2.8 3.2 3.8 4.2 4.8 Age (yrs) Moeller, M.P. (1997).Personal communication moeller@boystown.org ,
  • 5. Why Do Newborn Hearing Screening…… Vocabulary Size for Hearing Impaired Children Identified Before and After 6 Months of Age 300 Identified BEFORE 6 Months 250 Vocabulary Size Identified AFTER 6 Months 200 150 100 50 0 13-18 mos 19-24 mos 25-30 mos 31-36 mos (n = 15/8) (n = 12/16) (n = 11/20) (n = 8/19) Chronological Age in Months
  • 6. 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)
  • 7. SC Legislation – 1976 Code Section 44-37-40 "Universal Newborn Hearing Screening and Intervention Act"  Follow Up  Reporting &  All babies referred by hospital screening are to receive: Monitoring  Audiologic Evaluation by  NBHS reporting Audiologist, or procedures must be  Medical Evaluation by Physician or followed by: Otolaryngologist, or  Hospitals  Both if indicated  Audiologists  Confirmed HL:  Medical Intervention  Early Interventionists  Audiologic Habilitation  Early Intervention services  Augmentative Hearing Devices
  • 8. 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
  • 9. First Sound Process Refer to BabyNet Hospital Referred to Audiology Hearing Fail Audiologist for Fail Diagnostic CHL Habilitation Screening Re-Screen Evaluation Recs Pass Hearing Pass Normal Aids CI Sign Literature Lang Literature Literature Parent Support
  • 10. DATA COLLECTION  HOSPITALS  AUDIOLOGISTS  Started with paper data  Started with paper data collection collection  ~ 2003 began electronic  ~ 2003 began electronic data collection data collection  April 1, 2008 data  Report results of any collection process newborn referred by integrated with Vital hospital for follow up Records  Report screening results on every baby
  • 11. How Do We Test Babies? ?????
  • 12. How Do We Test Babies?
  • 13. 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
  • 14. Goals of EHDI 1–3-6  Screen by 1 month old  Confirmed diagnosis by 3 months old  In Early Intervention by 6 months old
  • 15. How Are We Doing? Screening Rate 100% 99% 98% 98% 97% 97% 97% 97% 97% 96% 96% 96% 95% 94% 93% 92% 90% AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
  • 16. How Are We Doing? Confirmed HL 120 106 100 85 82 74 77 75 80 68 62 58 60 40 40 20 0 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
  • 17. How Are We Doing? EI by 6 mos old 120% 100% 100% 88% 80% 63% 60% 58% 60% 51% 49% 53% 43% 38% 40% 20% 0% AAP 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
  • 18. How Are We Doing? Lost to Follow-Up/Documentation 50% 43% 40% 38% 37% 32% 33% 29% 30% 21% 23% 23% 20% 10% 0% 2003 2004 2005 2006 2007 2008 2009 2010 2011
  • 19. 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
  • 20. Things to Improve  Follow up rates for failed screen  Data reporting  Parent support
  • 21. Collaboration Opportunities  Home Visitation & ECHO Programs Report Screening Results Verification of Screening Report Results Diagnostic Results Report Need Audiology for Further Resource Follow Up
  • 22. FIRST SOUND Questions? Tara Carroll, MCD, CCC/A First Sound Program Manager/Audiologist 803-898-0708 carroltp@dhec.sc.gov