Issues in Implementing Early Hearing Detection and Intervention Programs

Issues in Implementing Early Hearing Detection and Intervention

Programs

If so, why?

What issues still need to be addressed?

Is Implementation of Universal Newborn Hearing Screening Accelerating?

Improved ScreeningTechniques/Equipment

Why is Implementation of Newborn Hearing Screening Accelerating?

Improved ScreeningTechniques/Equipment

Acceptance byPolicy Makers

Why is Implementation of Newborn Hearing Screening Accelerating?

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

Improved ScreeningTechniques/Equipment

Acceptance byPolicy Makers

Why is Implementation of Newborn Hearing Screening Accelerating?

Increased Number ofSuccessful Programs

Number of Hospitals Doing Universal Newborn Hearing Screening

3 3 11 26 60 120243

462

712

934

1384

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1200

1400

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Improved ScreeningTechniques/Equipment

Acceptance byPolicy Makers

Why is Implementation of Newborn Hearing Screening Accelerating?

Increased Number ofSuccessful Programs

PublicAwareness/Demand

Implementing Universal Newborn Hearing Screening

Enlisting Support for UNHS

Selecting an Appropriate Protocol

Procedural Issues

Communicating with Stakeholders

Training Screeners

Keeping Refer Rates Low

Managing Data and Patient Information

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Coordination and Reporting

Financing the Program

Care of Equipment

Diagnosis and Follow-up

Passing a Legislative Mandate

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Enlisting Support for UNHS

Support from authoritative groups

Many other hospitals are doing it successfully

Has newborn hearing screening already become the standard of care?

Physician support is essential

It won't happen without support of the nursing staff

Selecting Equipment and Determining an Appropriate Protocol for Your Hospital

Which equipment is best?

Selecting Equipment and Determining an Appropriate Protocol for Your Hospital

Which equipment is best?

Wouldn't it be better to wait for the next generation of screening equipment?

Selecting Equipment and Determining an Appropriate Protocol for Your Hospital

Which equipment is best?

Wouldn't it be better to wait for the next generation of screening equipment?

How many tests will be included in the screening protocol?

Protocols Used in Universal Newborn Hearing Screening Programs

Screening Procedures

Before Hospital Discharge After Hospital Discharge Number of Programs

TEOAE TEOAE and ABR 44DPOAE DPOAE 5AABR AABR 24AABR TEOAE 2

TEOAE and ABR ---------- 5TEOAE and AABR ---------- 2DPOAE and ABR ---------- 1

TEOAE ---------- 4DPOAE ---------- 3AABR ---------- 28ABR ---------- 2

Selecting Newborn Hearing Screening Equipment

Cost of equipment

Cost of supplies

Initial training

Time to screen

AABR or TEOAE or DPOAE

Selecting Newborn Hearing Screening Equipment (continued)

What is being measured?

AABR or TEOAE or DPOAE

what degree of hearing loss is detected?

availability of frequency specific information

which parts of auditory pathway are measured?

Selecting Newborn Hearing Screening Equipment (continued)

Scoring criteria and ease of interpretation

Flexibility of administration

Flexibility of use

Referral rates

AABR or TEOAE or DPOAE

Selecting Newborn Hearing Screening Equipment (continued)

Screening in noisy situations

False negatives

Cost per infant screened

AABR or TEOAE or DPOAE

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?

Procedural Issues

Who's in charge?

Who will do the screening?

Making sure every baby is screened

Scoring

Should screening be done with the parents present?

Communication: With Parents

Results of the screening test

When to communicate the results

What the test really means?

Awareness of language development milestones

Communication: With Physicians

General awareness of the program and its importance

What were the results for their patients?

Helping physicians understand the importance of follow up

Medical management issues

Communication: With the Hospital

Recording results in the child's medical record

Documenting the successes and difficulties of the program

Regular reports to hospital administrators

Justifying ongoing program support

Training

Initial training

Don't train more people than you need

Regular supervision

Retraining to accommodate staff turnover

Keeping Refer Rates Low

Schedule screening when babies are in the best behavioral state

Make a second effort to screen initial fails prior to discharge

Minimize noise and confusion in the screening area

Have backup equipment and supplies readily available

You don't need informed consent

For OAE procedures, probe fit is critical

For Automated ABR procedures, screen when myogenic activity is low

Data and Patient Information Management

Benefits of computer-based data management

Should you design your own, modify an existing, or purchase a system?

Safeguarding your data

Coordination and Reporting

Data-based program management and refinement

Make people aware of your successes

Coordination with early intervention programs

Coordination with other databases

Financing the Program

How much does it really cost?

Will insurance pay for newborn hearing screening?

Is newborn hearing screening cost beneficial?

Grants and donations

Care of Equipment and Supplies

An ounce of prevention is worth a pound of cure

Don't assume people know how to take care of computers

Most hospitals provide computer support--ask for it

Diagnosis and Follow up

A good screening program is not necessarily a good early identification program

Referral to pediatric audiologists

Age-appropriate techniques

Age at diagnosis

Provision of amplification

Timely, appropriate, family-centered intervention is the real goal

Legislative Mandates

Is legislation a good idea?

Don't wait to start until you have a legislative mandate

What's happening in other states?

Most Babies Are Already Being Screened. Do We Really Need a Legislative Mandate?

The last 10% to 20% is the toughest

Turnover of key staff or hospital ownership changes

Reporting and Data Management

Becoming a part of the Public Health System

Obtaining a Legislative Mandate

What should the bill contain?

Recruiting supporters

Negotiating the legislative process

When the legislation passes, the work begins

What Should the Bill Contain?

Strong differences of opinion - - ASHA model is one opinion

Pros and cons of including components in the law versus in Rules and Regulations

Short-term versus long-term strategies

Is a bad bill better than no bill?

Recruiting Support for the Bill

Parents

Responsible Executive Agency

Physicians

Audiologists

Hospital Administrators

Insurance Industry (public and private)

Advocacy Groups

Service Clubs (Quota, Lions, Sertoma, etc.)

Early Intervention Agency

Negotiating the Legislative Process

Three most important factors in getting a bill passed:Get the right sponsorGet the right sponsorGet the right sponsor

Emotion is more effective than logic

Don't fall asleep at the switch

It ain't over til it's over

When the Legislation Passes, the Work Begins

Writing the Rules and Regulations

Don't forget who helped you

Spreading the word

In God we Trust.......from all others, we require data

Legislation Is Not A Guarantee

In 1990, 16 states had legislative mandates for newborn hearing screening

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

Absence of appropriations limits the impact of many legislative mandates

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Status of Universal Newborn Hearing Screeningin the United States

.Percentage of Births

Screened

90%+

21 - 50%1 - 20%

3

51 - 90%