Download Early Childhood Hearing Screening in Iowa: What You Need to Know

Early Childhood Hearing Screening in
Iowa: What You Need to Know
Objectives
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Prevalence of hearing loss
OAE hearing screening
Advantages of OAE hearing screening
Establishing a screening program
OAE equipment costs
Training
EHDI Law/Rules – Reporting requirements
EHDI System of Care (SOC)
Resources
Incidence of Hearing Loss
• Hearing loss is the most frequently occurring birth
defect
• 92% of children with permanent hearing loss are
born to hearing parents.
• Approximately 12,000 babies are born with
permanent hearing loss in the U.S. each year (33
babies/day!!)
• Additionally, 1-2 per 1,000 will acquire hearing loss
after birth (late onset)
• Hearing loss can affect a child’s ability to develop
speech, language and social skills
Otoacoustic emissions (OAE)
hearing screening
• Performed with hand-held screening unit
• Small probe, fitted with a sensitive microphone, is placed
in the child’s ear canal
• Small probe delivers a low-volume sound stimulus into
the ear and the cochlea responds by producing an
otoacoustic emission (echo) analyzed by machine
• Result reads as pass or refer on
screening unit typically within 30-60
seconds
• Currently used by hospitals, PCPs,
audiologists and some Early Head
Start programs
Advantages of OAE Screening
• Subjective methods have not proven to be reliable for
screening children B-3 for HL
• Screen is quick, painless and does not require a
behavioral response
• Can help to detect permanent sensorineural HL and
call attention to a wide range of hearing health
concerns (ear infection, wax)
• Can be conducted in a variety of health and education
settings by individuals who have been trained to use
the equipment (is within the scope of their practice)
and are skilled in working w/young children
Establishing A Screening Program
• Contact state EHDI program
• Partner with local pediatric audiologist
• Decide on specific screening and follow-up protocol to be followed
(including referrals for treatment, EA referrals or Guide By Your Side
for newly diagnosed children)
• Explore equipment options, purchase
• Explore funding for hearing screening equipment, consumables
 Community grants
 Early childhood monies
 United Way, Lion’s Clubs, etc.
• Identify who will perform the OAE screening (PAT or partner with
AEA/local audiologist)
• Arrange for training of personnel
• Determine how each individual child's screening results recorded,
results shared with family and reported to state EHDI
OAE Equipment
• Costs between $3500 and $5000 to purchase
 May last 8-10 years with good care, recommend budget for
replacement after 5 years
• Maintenance – yearly equipment calibration
 Cost ranges from $300-$350/yr
• Consumables
 At least one probe cover per child
 Cost 20 cents to $1.00/each
• Equipment comparison/reviews
 NCHAM website
http://www.infanthearing.org/screening/equipment.html
 www.kidshearing.org/oaereviews
Training
• Determine who will provide training
 Work with the state EHDI program to explore regional training
 Work with local pediatric audiologist or local AEA audiologist to
provide training
 Utilize online training resources located at www.kidshearing.org
 www.infanthearing.org/videos/earlychildhood_hcs.html#oae4pcp
(link to page of hearing screening videos)
• Training to include:
 Why screening is important (1-3-6 goals for best outcomes
and late onset)
 Hearing screening protocols
 Follow up and referral
 Documentation of results
EHDI Law/Administrative Rules
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Iowa had good success with hospitals screening voluntarily prior
to 2004; but no surveillance system in place to ensure children
needing fup r’cd fup leading to late identification (school age)
Legislation went into effect January 1, 2004 which required:
 Universal hearing screening of all infants (prior to
hospital discharge)
 Facilitation of data to the department to enhance the
capacity of agencies & practitioners to provide services to
children & their families
 Reporting of all screenings, re-screenings & diagnostic
assessments to IDPH within six days of birth/six business
days of the screen/assessment for children under 3
 Allows sharing of data with bordering states for follow up
EHDI Law/Administrative Rules Cont’d
• Majority of providers use the EHDI web based data system to
report this information to IDPH, including audiology providers.
Demographics can be imported from admitting or electronic
health records. (reporting requirements includes demographics,
screen and rescreen results, diagnostic assessment results, risk
factors and child’s medical home, professional provider)
• The EHDI coordinator assigned within the department provides
administrative oversight to the early hearing detection and
intervention program within Iowa
• EHDI Advisory Committee representation
• Law (www.idph.state.ia.us/iaehdi/common/pdf/iaehdi_law.pdf)
• Rules (www.idph.state.ia.us/iaehdi/common/pdf/iaehdi_admin_rules.pdf)
Who makes up the EHDI System of Care
in Iowa?
• Iowa Department of Public Health provides
administrative oversight to the EHDI program within
Iowa
• www.idph.state.ia.us/iaehdi (EHDI website)
• www.idph.state.ia.us/ (IDPH website)
• Child Health Specialty Clinics
• www.chsciowa.org
• Birthing facilities, Audiologists (AEAs/Private), ENTs,
PCPs, Early ACCESS, EHS, occasionally healthcare
providers
Iowa EHDI Mission Statement
Iowa's Early Hearing Detection and Intervention
(EHDI) program works to ensure that all
newborns and toddlers with hearing loss are
identified as early as possible and provided with
timely
and
appropriate
audiological,
educational, medical intervention and family
support.
National EHDI 1-3-6 Goals
• "1" - All infants are screened (& rescreened in Iowa) for
hearing loss no later than 1 month of age.
• "3" - All infants who do not pass the screening will have
a diagnostic audiologic evaluation no later than 3
months of age.
• "6" - All infants identified with a hearing loss receive
appropriate early intervention services no later than 6
months of age.
Current EHDI Structure
IDPH
 By law universal screening and facilitation of appropriate follow up
among providers
 Surveillance (reporting by hearing healthcare providers for screens, rescreens and audiological assessments for children under 3 years of age)
 Program evaluation and data analysis
 Through MOU with CHSC, IDPH performs short term follow up (through
outpatient hearing screen)
CHSC
 Long term follow up (fup on children that need diagnostic assessment to
determine hearing status (normal vs. hearing loss)), referral to EA and
family support
 Family support - Guide By Your Side (GBYS)
 Risk factor follow up – children identified with risk factor for hearing loss
require letter be sent to family/PCP related to monitoring protocol
 Increasing awareness of recommended fup for medical home
eSP™ - EHDI Database
• Approximately 400 users, only permission to applicable children
• Used by EHDI staff, hospitals and audiology providers
(educational/private) across Iowa to capture demographics,
professional providers working w/family, screen, re-screen,
diagnostic assessment results and referrals, track fup
• Used to complete yearly CDC survey and provide data for grants
• Used to participate in CDC iEHDI pilot project/Sentinel data
project
• Used to track needed follow up and referrals
• Used for data analysis (intern and external requests)
• Used for program evaluation (meeting 1-3-6 goals)
• Used as tool to review hospital and audiology best practices or
lack thereof
Resources
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Comprehensive training resources and videos:
 http://www.kidshearing.org
 http://www.infanthearing.org/earlychildhood/library.html
Equipment comparison/reviews
 NCHAM website
http://www.infanthearing.org/screening/equipment.html
 www.kidshearing.org/oaereviews
Iowa Law and rules:
 http://www.idph.state.ia.us/iaehdi/common/pdf/iaehdi_law.pdf
 http://www.idph.state.ia.us/iaehdi/common/pdf/iaehdi_admin_rules.pdf
Reporting form for each screening:
 EHDI website,
http://www.idph.state.ia.us/iaehdi/common/pdf/newborn_hearing_screenin
g.pdf
 Contact EHDI program to utilize NCHAM/ECHO reporting form adapted for
Iowa and used by EHS programs (structure of form is based on protocol)
Questions????
Contact Information
Tammy O’Hollearn, Iowa EHDI Coordinator
Iowa Department of Public Health
[email protected]
(515) 242-5639 - direct
(515) 242-6013 - fax
Iowa EHDI website:
http://www.idph.state.ia.us/iaehdi/