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Pennsylvania Department of Health Out-of-Hospital
Birth Newborn Hearing Screening Initiative
National EHDI Conference
Washington, D.C.
February 2 -3, 2006
Arthur A. Florio, DOH EHDI Program Administrator
Patti Matlock, R.N., DOH Nursing Services Consultant
Lynn Shay, R.N., BSHS, CPM
Presenter Disclosure Information
In the past 12 months, we have not had a significant financial
interest or other relationship with the manufacturer(s) of the
product(s) or provider(s) of the service(s) that will be discussed
in our presentation.
This presentation will not include discussion of pharmaceuticals or
devices that have not been approved by the FDA or will be
discussing unapproved or “off-label” uses of pharmaceuticals or
devices.
Pennsylvania Facts
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Population 12,406,292
44,817 square miles
67 Counties and 2,567
municipalities
48 of 67 counties are rural
1/3 of the population lives
in a rural area
Pennsylvania’s Early Hearing
Detection & Intervention Program

1999 – began demonstration program in 26
birthing hospitals

IHEARR Act passed in November of 2001
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Statewide program implemented July 1, 2002

Universal EHDI in all 125 birthing hospitals
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~ 142,000 hospital births per year

Approx. 3,400 out-of-hospital births per year
2004 Hospital Hearing Screenings
160,000
141,465
Total Births
138,750
137,734
140,000
Newborns Screened
Initially
120,000
100,000
Newborns Completing
Screening
80,000
60,000
40,000
20,000
0
1,470
Newborn Not Passing
Screening
Why undertake a special effort to
screen Out-of-Hospital Births?
IHEARR Act specifically mentions the need to
screen out-of-hospital births within 30 days.
HRSA UNHSI grant has a requirement to assure
broadest possible representation of culturally
distinct groups in programs sponsored by MCHB.
Pennsylvania has historically concentrated cultural
communities where out-of-hospital birthing is
preferred. These communities have continued to
grow.
Out-of-Hospital (OOH) Births
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Pennsylvania had a total of 3,390 out-ofhospital births in 2003.
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1,066 OOH births (32%) occurred at
Freestanding Birthing Centers (FBCs); 120
FBC births were to out-of-state residents.
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2,324 OOH births (68%) occurred in
residences, midwives’ homes or other
locations (the majority were home births).
Geographic Concentrations
5
of the 15 FBCs accounted for 64% of
the 1066 births that took place in FBCs
during 2003.
5
counties accounted for 62% of all
OOH births in the residence, physician’s
office & other location category (i.e.,
places other than FBCs).
2003 OOH Births – Top 20 Counties of
Occurrence (all types included)
Erie
Warren
112
McKean
Bradford
Tioga
Potter
Susquehanna
Wayne
Crawford
43
Forest
Mercer
97
Wyoming
Venango
Cameron
Elk
Lackawanna
Sullivan
Pike
Lycoming
Clinton
Luzerne
Clarion
Jefferson
Lawrence
Columbia
Clearfield
Butler
Centre
33
Armstrong
Beaver
Mifflin
104
Indiana
120
Allegheny
135
Cambria
Carbon
Snyder
Northampton
Schuylkill
Lehigh
Dauphin
Blair
Perry
Westmoreland
Monroe
Union
211
Lebanon
38
Huntingdon
Berks
215
Bucks
Washington
Cumberland
86
Fayette
Somerset
Lancaster
1047
Bedford
Fulton
Greene
1,000 +
50 – 100
100 - 200
40 - 80
Franklin
99
Adams
York
38
Philadelphia
88
Chester
124
Delaware
78
2003 OOH Births – Areas of Concentration
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Red – Areas with concentrated home births (townships/boroughs with at least 5 and as
many as 104 home births – residence of mother)
Colored Dots with surrounding shading – Locations of FBCs and the twps./boroughs
where mothers who gave birth in those FBCs reside.
MIDWIVES DOING OOH BIRTHS

Certified Nurse Midwife (CNM)
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Certified Professional Midwife (CPM)
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Direct Entry Midwife (DEM)
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Traditional Midwife
Some RNs and midwife apprentices also
do newborn hearing screening for OOH
births.
Overcoming Barriers in Getting OOH
Birth Hearing Screening Started . . .

Lack of interest among midwives
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Midwives not convinced of its importance
– viewed hearing screening as an
additional unnecessary procedure
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Patients not interested
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Hospitals hesitant to allow hands-on
in-service training for midwives doing
OOH births
Getting Started . . .
Contact midwives in the counties with the
largest concentrations of OOH births
 Contact DOH district office community
health nurses
 Finding midwives interested in
performing newborn hearing screening
 FBCs are a good venue for hands-on
training

Establishing OOH Birth
Screening Networks . . .
 Traveling
Midwife
Networks
 Freestanding
Birthing Facilities
How Machines are Purchased

Advisory Committee helped
formulate equipment specifications
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Bid Procurement -- bid
specification is issued and vendors
submit bids

The lowest bid that meets all
requirements of the bid
specification gets the sale
Bid Specification Highlights . . .
Must be Portable
 Auditory Brainstem Response (ABR)
 Battery-powered (5-hour operating
capability on charge)
 Pass/Not-pass result indication
 Consumables for 500 screenings/unit
 3-year service agreement & warranty
 Vendor Training

Communication is Important
 Mailing
reports
and information
 Faxes
and e-mail
 Telephones
phones
and cell
CURRENT PLACEMENT OF PORTABLE ABR
SCREENING UNITS
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Pennsylvania’s EHDI program has purchased 15 portable ABR units
The units are currently deployed at the above locations
Upcoming prospective placement at Pittsburgh FBC
Another bid purchase is in process for 5 additional units
Preparing for Hearing Screening
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Quiet environment
Make sure infant is
tired and fed
Identify and prepare
sensor sites
Connect Sensors
Fit ear-tip on the probe
Prepare the machine
View results and
record results
Maintaining the Networks
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15 portable ABR screening units in use
6 traveling midwives share 3 machines
12 units are at FBCs
Maintaining equipment
- 5 machines need yearly replacement cables
- knowledge of warranties
Budgeting for and ordering supplies
Reports
Division of Newborn Disease Prevention and Identification
PO Box #90, Harrisburg PA, 17108-0090
Submitter
Keep Top Copy
1234567
Phone: (717) 783-8143 TTY: (717) 783-6514
Out of Hospital Births
This form is for out of hospital births and includes Hearing Screening
DRAW
DATE
TIME
FIRST
AM
PM
LOCATION OF BIRTH:
HOME
DRAWN BY
____________________________
MOTHER’S SOCIAL SECURITY NUMBER
HEARING SCREENING: (OUT OF HOSPITAL BIRTHS ONLY)
PHONE NUMBER
MOTHER’S LAST NAME
FIRST
ADDRESS
CITY, STATE, ZIP
PHONE (MOTHER)
L-XXXXXXX
OTHER
BIRTHING CENTER
BIRTHTIME
BABY’S MED. REC. NO. BABY’S RACE
AM
SEX
WHITE
ASIAN
F
PM
BLACK
AM. IND.
BIRTH
GESTATION
BIRTHWEIGHT
PAC. IS.
OTHER
SINGLE
OTHER ____ HISPANIC ?
(WEEKS)
(GRAMS)
A
B
C
YES
NO
TRANSFUSED?
SPECIMEN
PREV. CARD #
SM. VOL
INITIAL
MATERNAL HEPATITIS B STATUS
EXCHANGE
REPEAT
DATE __________
Hbs Ag
POS.
NEG.
?
FORM SUBMITTED BY
MIDWIFE
CHECK HERE IF BABY IF
BABY IS LESS
THAN 24 HRS. OLD
M
BIRTHDATE
NAME
OF SCREENER: ______________________DATE: __________
BABY’S PHYSICIAN
R. Ear Pass ____ Refer ____ Not Screened ____ Refused ____
L. Ear Pass ____ Refer ____ Passed but High Risk Factor ____
MOTHER’S MEDICAL ASSISTANCE #
LAST
NAME
ADDRESS IF OTHER THAN BIRTH FACILITY
FIRST
NAME
OOH Birth Filter Paper
1234567
BABY’S LAST NAME
S & S 903 LOT # W-011 (Rev. 12/02)
Pennsylvania Department of Health
Success of Program
Diagnosed 2 newborn infants with
hearing loss
 Both infants have amplification
 Awareness among the Lancaster County
about hearing screening and the outcome
 More interest among the midwives in
screening
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Challenges
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Fluctuating birthing volumes
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Generating interest among clientele
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Equipment recalls
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Cooperation among midwives sharing
screening units
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Submission of data and referrals
Goals for 2006
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Purchase 5 ABR hearing machines
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Screen 50-60% of OOH births
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Provide educational updates for
midwives
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Initiate feedback newsletter for midwifes
Serving special sub-groups of the
population in Pennsylvania
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The Plain People
Agrarian
communities
Rural residents
Complementary
healthcare seekers
Barriers to screening in subgroups
The Old Order Amish and
Mennonites
 Cost
of test and subsequent treatment
 Transportation
and access
The Old Order Amish and
Mennonites
 Educational
level
 Reliance on non-allopathic healthcare
 Community belief systems
Routine preventive care devalued
Technology
Avoid being unique
Advice from grandparents
Government aid
Other Plain Groups, Farmers, Rural
Dwellers and Complementary
healthcare groups
Cost
 Transportation
 Ease of accessibility
 Distrust of government programs
 Distrust of allopathic healthcare/technology

Removing the Barriers
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Personal relationship with the provider
Patient education
Free testing
Portable process
Incorporation into routine care
Viewing hearing screening as a standard of care
Relating early treatment to adult productivity
Cultural Competence:
The chameleon effect
Home visits
“Hitching posts”
Personal relationship
The teachable moment
Informing multiple
generations
Net results for outreach screening
services:
Decreasing disparity in healthcare services
to population sub-groups (Healthy People
2010 goal)
 Increased screening to children at risk
 Increased awareness of importance of
prevention, screening and early intervention
among often marginalized groups

Screening and Intervention
Linked
 Screening
followed by
intervention in all subgroups
 Intervention
amenable
Summary and Lessons Learned
Research is Key
 Identify and Overcome Barriers
 Recognize Cultural Diversities
 Program Requires Investment of Staff
Time and Effort
 Develop Relationships Based on Trust
 Communications
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