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Effective Hearing Screening Practices in Health Care Settings

This resource explores partnerships, protocols, and challenges of hearing screening in community health clinics, emphasizing the importance of early detection and periodic screenings. It also discusses future developments and essential elements for successful implementation.

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Effective Hearing Screening Practices in Health Care Settings

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  1. Effective Hearing Screening Practices in Health Care Settings Randi Winston, William Eiserman, Lenore Shisler

  2. Partnerships The EAR Foundation of Arizona The Nina Mason Pulliam Foundation • Local funding resource in Arizona • Provided funding for: • program development • 11 OAE screeners • implementation of 5 CHC clinics

  3. Partnerships Arizona Association of Community Health Clinics • Community Health Centers (CHC's) provide primary health care in rural and medically underserved areas. Health care services offered include Family Practice, Internal Medicine, Pediatric, Obstetrical, Dental and ancillary health care. • There are thirty-four not-for-profit, community-based, primary care organizations in Arizona with over 100 sites located throughout the state. • Community Health Centers are not-for-profit providers, governed by boards whose members are citizens of the communities they serve. Governed by a system that ensures quality of care is upheld. Centers all over the state catering to underserved populations.

  4. Partnerships National Center for Hearing Assessment and Management • Protocol development • based on experience with Hearing Head Start Project • Training Materials • Modification of already established training materials • Training Process

  5. Rationale for Ongoing Periodic ScreeningBirth to Three • Although all newborns in Arizona are screened at birth, as many as 40% are lost to follow up in between the first and second screens • Babies missed in the hospital screening programs • Babies born outside of AZ that never had a screen

  6. Rationale for Ongoing Periodic ScreeningBirth to Three • Babies born with risk factors for late onset and progressive losses • Babies born with milder forms of losses that were not identified by hospital screening program • Infants and children that acquire chronic otitis media

  7. Rationale for Ongoing Periodic ScreeningCommunityHealth Care Settings • High volume clinics • Provides a safety net to catch kids that have fallen through the cracks • Early childhood screenings are an established part of well-child visits • Current screening methods are unreliable • New technology makes it feasible for non-audiology staff to conduct screenings • Eliminates need for referrals to PCPs thus minimizing steps for follow-up

  8. Protocol Development ObjectivesCommunityHealth Care Settings • Importance of incorporating screening into already established activities • Simple, sensible format and guide for screeners and physicians to follow • Establishment of “no brainer” protocols • Periodicity protocols • How often should screenings be conducted • Well child visit • JCIH risk indicators for late onset and progressive hearing loss, parental concerns, speech delays, OM • Screening protocols • Follow-up on kids not passing OAE

  9. Hearing Screening Form Shisler and Eiserman

  10. Training and ImplementationCommunityHealth Care Settings • Set up trainings in each of the clinics • Meet with physicians • Education • Determine protocols • Conduct staff training • Data collection to monitor screening outcomes • Track reimbursement outcomes

  11. Challenges to ConsiderCommunityHealth Care Settings • Significant time constraints • staff training issues • physician training and education • Environment is often chaotic; difficult to complete screening session on kids that are non-compliant. • completion of recommended screening protocol • keeping track of kids that need follow-up and that need to be screened more often

  12. Challenges to ConsiderCommunityHealth Care Settings • Staff turnover • Physicians • Medical assistants • Language barriers • Methods often used for middle ear assessment • Care coordination methods

  13. Future Developments Funding provided to NCHAM by the Oticon Foundation • The Oticon Foundation is currently providing funding to NCHAM to develop physician and staff training materials promoting continuous OAE screening in healthcare settings, including: • A video for EHDI Coordinators or others to use when making presentations to physicians. • An overview pamphlet/booklet for physicians summarizing the main points and protocol. • A set of written and video materials for training medical staff (nurses and medical assistants). • Checklists for physicians/staff covering the logistics of implementing continuous OAE screening.

  14. ConclusionImplementations Considerations • Data reportingto a central tracking program • Coordination of activities related to screening • Program maintenance • Training new staff • Care coordination for follow ups (ensuring families come back for rescreens) • Equipment sharing in busy offices • Equipment reliability • Reimbursement Issues

  15. ConclusionEssential Elements • Well trained staff • Physicians and screening staff • Screening activities • Follow-up and referrals • Plan in place for training new staff • Program Management • Equipment that is dependable • Protocol to guide screening activities

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