Download all hearing screenings

What’s Missing Hear?
Michigan Academy of
Physician Assistants
(MAPA)
October 11, 2013
Dee Robertson, MA, CRC,
Community Consultant
Michigan Early Hearing Detection and Intervention (EHDI) Program
517-373-8601; [email protected]
www.michigan.gov/ehdi
Early Hearing Detection and
Intervention (EHDI) Program
National and state initiative promoting
“1-3-6 Goals”:

All newborns will be screened for hearing loss
no later than 1 month of age, preferably before
hospital discharge.

Those not passing screening should have a
comprehensive audiologic evaluation
no later than 3 months of age.

All infants identified with hearing loss will
receive appropriate early intervention services
no later than 6 months of age.
Why screen for hearing loss?
Incidence –
National averages
3/1000 normal births
33/day
12,000 every year.
Why screen early?
Untreated hearing loss, especially in young
children, has negative
affects on:
Speech and language.
Developmental skills.
Academic achievement.
Social-emotional development.
“Early Intervention” Is Critical!
Children identified and receiving services
younger than 6 months of age have
larger vocabularies,
better comprehension
better expressive language
than children identified and introduced
to services at greater than 6 months of age.
Cost savings
The importance of early screening
early diagnosis and early
intervention.
Cost of hearing screening versus
audiological test battery.
Cost and risks of sedated vs
unsedated ABR.
Cost Savings
TAXES – Yours and Mine!
Special education.
Employment: $1 Million less in earnings over
a lifetime!
Because it is the law……
Medicaid policy, March, 2000:
Hospitals >15 Medicaid births must provide
newborn hearing screening.
Mandated Reporting of Hearing Screening &
Diagnosis – 2006. (Michigan PA 31 of 2006)
Mandated Newborn Hearing Screening (April
2008).
Mandated reporting
Mandated reporting: Public Act 31 of 2006 (SB
794).
Medical professionals must report to the
state:
-
all hearing screenings on children less
than twelve months of age; and
all diagnosed hearing loss in children
under three years of age.
FACT:
While over 95% of
US newborns
are screened for
hearing loss at birth,
national data suggest that
approximately 50% of
screening referrals are
lost to follow up.
How Are We Doing in Michigan?
National and State
EHDI Goal # 1.
All newborns will be
screened for hearing
loss no later than 1
month of age,
preferably before
hospital discharge.
HEARING SCREENS
REMEMBER
1 SCREEN
+ 1 SCREEN
2 (TO) AUDIOLOGY
Michigan 2007-2011
Improvement SLOWLY progressing
Lost to Follow-Up (LTF)
Birth Year Referred
2007
1925
2008
1639
2009
1518
2010
1531
2011
1557
LTF
1176
954
800
833
822
61.1%
58.2%
52.7%
54.4%
52.8%
*Number and percent of infants lost to follow-up after refer from final
hearing screen: MI EHDI Data, 2007-2011.
National and State
EHDI Goal # 2.
Those not passing screening
should have
a comprehensive
audiologic evaluation
no later than
3 months of age.
Data* tells us:

Michigan 2011: (Births are down over 20% since 2000)




113,229 births
111,411 screened (98%)
105,817 passed within one month of birth.
1,557 did not pass (from all screens performed)
o
o
o

166 infants had a documented hearing loss.
18 babies initially passed but were subsequently diagnosed with
Late-onset permanent hearing loss.
822 had no follow-up at all (52.8%).
Potentially: we have many more infants with undiagnosed
hearing loss (5 more have been diagnosed since this report.)
*Centers for Disease Control DSHPSHWA Annual Report January 2013.
National and State
EHDI Goal #3.
All infants identified with
hearing loss will receive
appropriate early
intervention services
no later than
6 months of age.
Critical Care Unit
How Can Physician’s Assistants Help?
- Ask parent/guardian about hospital
hearing screen at first “well baby” check.
-
Confirm screen results in MCIR.
-
Review steps in MCIR action page.
How Can Physician Assistants Help?
- Encourage parents to follow up with appropriate
testing with a Pediatric Audiologist skilled in
diagnosing infants.
-
Do NOT adopt the “wait and see attitude.”
-
-
“Just fluid” may mask permanent hearing loss.
Monitor baby’s developmental progress,
-
Even if hearing is fine at birth,
hearing loss can start at any age.
Michigan Care Improvement Registry
Hearing (EHDI) tab
will show all hearing results reported
approximately 1 week after report.
MCIR - EHDI Screens
MCIR - EHDI Screens
Screen Results
ACTION
Fail
▪ If this is an initial failed screen then a hearing re-screen needs to be completed no later than one
month of age.
▪ If this is a failed re-screen then immediately send child for a diagnostic evaluation by a
pediatric audiologist. Refer to www.michigan/ehdi for a list of pediatric audiologists in your area.
Incomplete
▪ Hearing screen needs to be completed no later than one month of age. (If newborn was in neonatal
intensive care unit (NICU) it is recommended to have an automated auditory brainstem response
screen (A-ABR).
▪ If incomplete screen is due to parent refusal encourage family to have hearing tested.
Pass
▪ Monitor speech-language development.
▪ Review risk factors for late onset and progressive hearing loss (www.jcih.org) and ensure that
diagnostic evaluation is completed at least once by 3 years of age.
Diagnostic Results
ACTION
Undetermined and
Conductive
(Transient)
▪ Further diagnostic testing needs to be completed. Send child to a pediatric audiologist immediately
for appropriate follow-up testing. Refer to www.michigan/ehdi for a list of pediatric audiologists in
your area.
▪ Do not assume it is only middle ear effusion.
Sensorineural
Auditory
neuropathy
Mixed
Conductive
(permanent)
▪ Enrollment in intervention, contact Early On (1-800-Early On).
▪ Medical evaluations to determine etiology, identify related conditions, and recommend treatment.
Includes referrals to ophthalmology, genetics, otology, developmental pediatrics, neurology,
cardiology, and nephrology if appropriate.
▪ Ensure ongoing pediatric audiology services.
▪ Ensure parent support for families, refer to the Guide-By-Your-Side parent support program. Call
517-335-8273.
Within Normal
Limits
• Monitor speech and language development milestones.
▪ A child is still at risk for late onset or progressive hearing loss (www.jcih.org).
Run a Batch Report of
all children coming in
for the day for hearing
status and who needs
follow-up!
Is it a Pass?
Baby John Doe is born at 11:00 p.m. on Tuesday.
He has his Newborn Hearing Screening at 2:00 p.m. on Wednesday.
He passes in his Left ear, but refers/fails in his Right ear.
Before discharge on Thursday morning, he has another hearing screen.
He refers/fails in his Left ear, but passes in his Right ear.
How would you interpret these results in MCIR?
Is follow-up needed?
Early is better, but it’s not over!
Remember – it’s now or
MUCH later.
1.
2.
Infant hearing screen, etc.
Kindergarten hearing screen.
Provider Guidelines, November 2008
ONGOING CARE OF ALL INFANTS
•
Provide parents with information about hearing, speech, and
language milestones.
•
Identify and aggressively treat middle ear disease. This is
especially critical in children with confirmed hearing loss as middle
ear effusion may further compromise hearing.
•
Vision screening and referral as needed.
•
Referrals to otolaryngology and genetics, as needed
•
Monitor risk indicators for late onset hearing loss.
After diagnosis – then what?
Michigan EHDI sponsors the
Guide-By-Your-Side program.
- Experienced, trained parent of a child
with hearing loss.
- Unbiased discussion of communication modes
and options.
- Free resource for parents.
For more info: www.michigan.gov/ehdi
After diagnosis – then what?
Michigan Hands & Voices
Peer support group for parents and families of
children of all ages with hearing loss.
Organization for professionals working with
these families and children.
www.mihandsandvoices.org
Loss & Found™ DVD
Joint Committee on Infant Hearing
(JCIH) Recommendations
For rescreening, a complete screening on
both ears is recommended, even if only
one ear failed the initial screening.
For infants who do not pass Automated ABR in
the NICU, referral should be made directly
to an audiologist … for comprehensive
evaluation including ABR.
www.jcih.org.