Issues in Implementing Early Hearing Detection and Intervention Programs

1. Issues in Implementing Early Hearing Detection and Intervention Programs

2. Is Implementation of Universal Newborn Hearing Screening Accelerating? If so, why? , What issues still need to be addressed? ,

3. Why is Implementation of Newborn Hearing Screening Accelerating? Improved Screening Techniques/Equipment

4. Why is Implementation of Newborn Hearing Screening Accelerating? Improved Screening Techniques/Equipment Acceptance by Policy Makers

5. 1988: Commission on Education of the Deaf ) 1990: Healthy People 2000 Report ) 1993: NIH Consensus Statement ) 1994: Joint Committee on Infant Hearing ) 1998: American Academy of Pediatrics )

6. Why is Implementation of Newborn Hearing Screening Accelerating? Improved Screening Techniques/Equipment Increased Number of Acceptance by Successful Programs Policy Makers

7. Number of Hospitals Doing Universal Newborn Hearing Screening Number of Programs

8. Why is Implementation of Newborn Hearing Screening Accelerating? Improved Screening Techniques/Equipment Acceptance by Increased Number of Policy Makers Successful Programs Public Awareness/Demand

9. Implementing Universal Newborn Hearing Screening 1. Enlisting Support for UNHS 8. Coordination and Reporting 2. Selecting an Appropriate 9. Financing the Program Protocol 10. Care of Equipment 3. Procedural Issues 11. Diagnosis and Follow-up 4. Communicating with Stakeholders Passing a Legislative 12. Mandate 5. Training Screeners 6. Keeping Refer Rates Low 7. Managing Data and Patient Information

10. Enlisting Support for UNHS Support from authoritative groups 2 Many other hospitals are doing it successfully 2 Has newborn hearing screening already become 2 the standard of care? Physician support is essential 2 It won't happen without support of the nursing 2 staff

11. Selecting Equipment and Determining an Appropriate Protocol for Your Hospital Which equipment is best? 2

13. Selecting Equipment and Determining an Appropriate Protocol for Your Hospital Which equipment is best? 2 Wouldn't it be better to wait for the 2 next generation of screening equipment?

14. Selecting Equipment and Determining an Appropriate Protocol for Your Hospital Which equipment is best? 2 Wouldn't it be better to wait for the next 2 generation of screening equipment? How many tests will be included in the 2 screening protocol?

15. Protocols Used in Universal Newborn Hearing Screening Programs Screening Procedures Before Hospital Discharge After Hospital Discharge Number of Programs TEOAE TEOAE and ABR 44 DPOAE DPOAE 5 AABR AABR 24 AABR TEOAE 2 TEOAE and ABR ---------- 5 TEOAE and AABR ---------- 2 DPOAE and ABR ---------- 1 TEOAE ---------- 4 DPOAE ---------- 3 AABR ---------- 28 ABR ---------- 2

16. Selecting Newborn Hearing Screening Equipment AABR TEOAE DPOAE or or Cost of equipment 2 Cost of supplies 2 Initial training 2 Time to screen 2

17. Selecting Newborn Hearing Screening Equipment (continued) AABR TEOAE DPOAE or or What is being measured? 2 what degree of hearing loss is detected? 4 availability of frequency specific information 4 which parts of auditory pathway are measured? 4

18. Selecting Newborn Hearing Screening Equipment (continued) AABR TEOAE DPOAE or or Scoring criteria and ease of interpretation 2 Flexibility of administration 2 Flexibility of use 2 Referral rates 2

19. Selecting Newborn Hearing Screening Equipment (continued) AABR TEOAE DPOAE or or Screening in noisy situations 2 False negatives 2 Cost per infant screened 2

20. Summary: Selecting the Best Newborn Hearing Screening Equipment • What do you want the equipment to do? • What is the cost of purchase and use? • How good is customer support?

21. Procedural Issues Who's in charge? 2 Who will do the screening? 2 Making sure every baby is screened 2 Scoring 2 Should screening be done with the parents 2 present?

22. Communication: With Parents Results of the screening test 2 When to communicate the results 2 What the test really means? 2 Awareness of language development 2 milestones

23. Communication: With Physicians General awareness of the program and its 2 importance What were the results for their patients? 2 Helping physicians understand the 2 importance of follow up Medical management issues 2

24. Communication: With the Hospital Recording results in the child's medical 2 record Documenting the successes and difficulties 2 of the program Regular reports to hospital administrators 2 Justifying ongoing program support 2

25. Training Initial training 2 Don't train more people than you need 2 Regular supervision 2 Retraining to accommodate staff turnover 2

26. Keeping Refer Rates Low Schedule screening when babies are in the best behavioral state 2 Make a second effort to screen initial fails prior to discharge 2 Minimize noise and confusion in the screening area 2 Have backup equipment and supplies readily available 2 You don't need informed consent 2 For OAE procedures, probe fit is critical 2 For Automated ABR procedures, screen when myogenic activity 2 is low

27. Data and Patient Information Management Benefits of computer-based data management 2 Should you design your own, modify an existing, or purchase a system? 2 2 Safeguarding your data

28. Coordination and Reporting Data-based program management and 2 refinement Make people aware of your successes 2 Coordination with early intervention 2 programs Coordination with other databases 2

29. Financing the Program How much does it really cost? 2 Will insurance pay for newborn hearing 2 screening? Is newborn hearing screening cost beneficial? 2 Grants and donations 2

30. Care of Equipment and Supplies An ounce of prevention is worth a pound of 2 cure Don't assume people know how to take care of 2 computers Most hospitals provide computer support--ask 2 for it

31. Diagnosis and Follow up A good screening program is not necessarily a good 2 early identification program Referral to pediatric audiologists 2 Age-appropriate techniques 2 Age at diagnosis 2 Provision of amplification 2 Timely, appropriate, family-centered intervention is 2 the real goal

32. Legislative Mandates Is legislation a good idea? 2 Don't wait to start until you have a legislative 2 mandate What's happening in other states? 2

33. Most Babies Are Already Being Screened. Do We Really Need a Legislative Mandate? The last 10% to 20% is the toughest 2 Turnover of key staff or hospital ownership 2 changes Reporting and Data Management 2 Becoming a part of the Public Health System 2

34. Obtaining a Legislative Mandate What should the bill contain? 2 Recruiting supporters 2 Negotiating the legislative process 2 When the legislation passes, the work begins 2

35. What Should the Bill Contain? Strong differences of opinion - - ASHA model is 2 one opinion Pros and cons of including components in the 2 law versus in Rules and Regulations Short-term versus long-term strategies 2 Is a bad bill better than no bill? 2

36. Recruiting Support for the Bill Parents 2 2 Responsible Executive Agency 2 Physicians 2 Audiologists 2 Hospital Administrators 2 Insurance Industry (public and private) 2 Advocacy Groups 2 Service Clubs (Quota, Lions, Sertoma, etc.) 2 Early Intervention Agency

37. Negotiating the Legislative Process Three most important factors in getting a bill passed: 2 Get the right sponsor ) Get the right sponsor ) Get the right sponsor ) Emotion is more effective than logic 2 Don't fall asleep at the switch 2 It ain't over til it's over 2

38. When the Legislation Passes, the Work Begins Writing the Rules and Regulations 2 Don't forget who helped you 2 Spreading the word 2 In God we Trust.... 2 ...from all others, we require data )

39. Legislation Is Not A Guarantee In 1990, 16 states had legislative mandates for newborn hearing screening 2 7 of those had no program ) 6 of the 9 programs were not state wide ) Dpmt of Educ officials in 10 of 16 states unaware legislation existed ) Rules and regulations are often as important as legislation 2 Absence of appropriations limits the impact of many legislative mandates 2

40. 3 Status of Universal Newborn Hearing Screening in the United States . Percentage of Births Screened . 90%+ 51 - 90% 21 - 50% 1 - 20%