Transcript Document

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Military Audiology Association
February 13, 2006
John Eichwald, Team Lead
Centers for Disease Control and Prevention
National Center on Birth Defects
and Developmental Disabilities
Division of Human Development and Disability
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Congenital Defects/Diseases
Incidence per 10,000
30
25
20
13.6
13.1
8.3
10
4.2
2.5
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ss
0
MACDP NCBDDD 2004
Conditions Screened in the Newborn
Incidence per 10,000
30
25
20
10
4
2.2
1.9
0.7
0.5
0.1
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LT
G
A
PK
U
AH
C
F
C
SS
H
C
H
L
0
NNSGRC 2003
Grade Equivalents
Reading Comprehension Scores of
Hearing and Deaf Students
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
Deaf
Hearing
8
9
10
11
12
13
14
15
16
17
18
Age in Years
Schildroth, A. N., & Karchmer, M. A. (1986). Deaf children in America, San Diego: College Hill Press.
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Study of Early versus Late Identification
Language Age (yrs)
6
Identified <6 mos (n = 25)
Identified >6 mos (n = 104)
5
4
3
2
1
0
0.8
1.2
1.8
2.2
2.8
3.2
3.8
4.2
4.8
Age (yrs)
129 deaf and hard-of-hearing children assessed 2x each year.
Assessments done by trained diagnostician as normal part of early intervention program.
Moeller, M.P. (1997). Boys Town National Research Hospital
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Universal Newborn Hearing Screening
Endorsement
• American Academy of Audiology (AAA)
• American Academy of Pediatrics (AAP)
• American Speech-Language-Hearing Association
(ASHA)
• Centers for Disease Control and Prevention (CDC)
• Joint Committee on Infant Hearing (JCIH)
• Maternal and Child Health Bureau (MCHB)
• National Association of the Deaf (NAD)
• National Institutes of Health (NIH)
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CDC EHDI Vision and Mission
•
The vision of the Early Hearing Detection
and Intervention (EHDI) program is to
promote communication from birth for all
children.
•
The mission of EHDI is for every state and
territory to have a complete EHDI tracking
and surveillance system that ensures
children with hearing loss achieve
communication and social skills
commensurate with their cognitive abilities.
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Children’s Health Act of 2000
Public Law 106–310
DIVISION A—CHILDREN’S HEALTH
TITLE VII—EARLY DETECTION, DIAGNOSIS, AND
TREATMENT REGARDING HEARING LOSS IN INFANTS
The purposes of this title are to clarify the authority within the
Public Health Service Act to authorize statewide newborn
and infant hearing screening, evaluation and intervention
programs and systems, technical assistance, a national
applied research program, and interagency and private
sector collaboration for policy development, in order to
assist the States in making progress toward the following
goals:
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Children’s Health Act of 2000
Public Law 106–310
(1) All babies born in hospitals in the United States and its
territories should have a hearing screening before leaving
the birthing facility.
(2) All babies who are not born in hospitals in the United
States and its territories should have a hearing screening
within the first 3 months of life.
(3) Appropriate audiologic and medical evaluations should be
conducted by 3 months for all newborns and infants
suspected of having hearing loss to allow appropriate
referral and provisions for audiologic rehabilitation,
medical and early intervention before the age of 6 months.
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Children’s Health Act of 2000
Public Law 106–310
(4) All newborn and infant hearing screening programs and
systems should include a component for audiologic
rehabilitation, medical and early intervention options that
ensures linkage to any new and existing state-wide
systems of intervention and rehabilitative services for
newborns and infants with hearing loss.
(5) Public policy in regard to newborn and infant hearing
screening and intervention should be based on applied
research and the recognition that newborns, infants,
toddlers, and children who are deaf or hard-of-hearing
have unique language, learning, and communication
needs, and should be the result of consultation with
pertinent public and private sectors.
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Children’s Health Act of 2000
DIVISION A — CHILDREN’S HEALTH
TITLE VII — EARLY DETECTION, DIAGNOSIS, AND
TREATMENT REGARDING HEARING LOSS IN
INFANTS
Health Resources and Services Administration (HRSA) shall:
make awards of grants or cooperative agreements to
develop statewide newborn and infant hearing screening,
evaluation and intervention programs and systems
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Children’s Health Act of 2000
The Centers for Disease Control and Prevention shall:
• develop standardized procedures for data management
• provide technical assistance on data collection and
management
• promote the sharing of data regarding early hearing loss
with state-based birth defects and developmental
disabilities monitoring programs
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Children’s Health Act of 2000
The Centers for Disease Control and Prevention (CDC) shall:
develop standardized procedures for data management and
program effectiveness and costs, such as to:
• ensure quality monitoring of newborn and infant hearing
loss screening, evaluation, and intervention programs and
systems;
• provide technical assistance on data collection and
management;
• to study the costs and effectiveness of newborn and infant
hearing screening, evaluation and intervention programs
and systems conducted by State-based programs in order
to answer issues of importance to State and national
policymakers;
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Children’s Health Act of 2000
National Institutes of Health (NIH) shall:
continue a program of research and development on the
efficacy of new screening techniques and technology,
including clinical studies of screening methods, studies on
efficacy of intervention, and related research.
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87.2% Newborns Screened (2003)
(n = 47)
WA 81%
VT 93%
MT 97%
ND 95%
OR 95%
ID 83%
MN
93%
NH 91%
NY
92%
WI 93%
SD 90%
MI*
WY 98%
NV
99%
NE 97%
PA 98%
IA
IL
100%
UT 98%
CO 97%
CA 56%
KS 97%
IN
99%
OH
40%
WV
98% VA
96%
KY 99%
MO
99%
NC 96%
OK 96%
AZ
TN 97%
AR 92%
NM 92%
TX 97%
LA
94%
SC 98%
MS
95%
AL
96%
GA 96%
AK 81%
FL
86%
>90% HP 2010 28-11 Target
HI 99%
>65% HP 2010 28-11 Baseline
<65%
Not Reported
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ME
94%
MA 99%
RI 99%
CT 97%
NJ 98%
DE 83%
MD 91%
55.9% Audiological Evaluation (2003)
(n = 35)
WA
ND
43%
MT*
MN
53%
OR 35%
ID 100%
WY 94%
UT 66%
CA
80%
CO
89%
MI*
PA
60%
IA
IN
IL
77%
KS 77%
OH
17%
WV
66% VA
70%
KY 14%
MO
20%
NC*
OK 32%
AZ
TN 61%
AR 47%
NM
TX
LA
65%
SC 65%
MS
84%
AL
GA
14%
AK
FL
>70% HP 2010 28-11 Target
HI 74%
>55% HP 2010 28-11 Baseline
<55%
Not Reported
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ME
NH 9%
NY
25%
WI
SD
69%
NE 82%
NV
VT
86%
MA 85%
RI 95%
CT 73%
NJ 53%
DE 100%
MD 27%
67.3% Intervention by 6 months (2003)
(n = 34)
WA
VT
0%
ND
MT*
MN
100%
OR 39%
SD
100%
ID 100%
NH 64%
NY
61%
WI
MI*
WY 100%
NE 67%
NV
IA
UT 41%
CA
87%
IN
67%
IL
29%
CO 45%
KS 84%
MO
52%
PA
64%
OH
28%
KY 100%
WV
75% VA
63%
NC
OK 91%
AZ
NM
50%
TN 100%
AR 64%
TX
LA
53%
SC*
MS
85%
AL
GA
AK 0%
FL
>90% HP 2010 28-11 Target
HI 83%
>65% HP 2010 28-11 Baseline
<65%
Not Reported
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ME
MA 71%
RI 100%
CT 100%
NJ 75%
DE 100%
MD
Births: Combined US Military Forces
• Approximately 95,000 military families each year - more
individual births than all but the 12 largest states
• Approximately 40% of these births occur at military
facilities
• Military births take place in all 50 states and more than 20
foreign countries (8.5%)
• More than 2,000 military births per year occur in each of
11 states:
– CA, CO, FL, GA, HI, KY, MD, NC, TX, VA, and WA
Non-US sites:
– Germany and Japan (both > 2,000)
– 3,700 in other sites
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Military Hospitals
Air Force
Army
Navy
Hawaii
Puerto Rico
Guam
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Recent CDC EHDI Activities
• DoD Birth and Infant Health Registry (BIHR)
05 Jan 06
• telephone call with LCDR Margaret Ryan, M.D.
(Navy) Director, DoD Center for Deployment Health
Research and Christina Spooner, M.S., coordinator
for the BIHR
– Surveillance for birth defects in partnership with
CDC’s National Birth Defects Prevention Network
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DoD Birth and Infant Health Registry
• Preliminary BIHR results suggest a steady increase in
the use of V72.1 (examination of ears and hearing)
since 1998 with a large increase in the year 2000
– Increase in services or reporting?
• Approximately 1/3 of reported military births had this
code associated with their obtained services in 2003
• BIHR will continue to explore codes in their data set
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11 Jan 06 Teleconference
Army (Walter Reed):
Air Force:
Navy:
Donna MacNeil, M.A., FAAA
CPT Alicia Burke, M.A.
CDR Leslie Sims, M.S., FAAA
CDR Margaret Ryan, M.D.
CDR Michelle Gasper, M.D.
CPT Martin McCaffrey, M.D.
LT Anne Jarrett, M.A. CCC-A
Christina Spooner, M.S.
BUMED (D.C.)
CDC:
CDR Khin Aungthein, RNC, MSN
John Eichwald, M.A., FAAA
Craig Mason, Ph.D.
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Teleconference Issues Identified
• Most military programs are felt to be reporting data to
their respective state EHDI program
• There is no uniform reporting of EHDI data or
centralized database for military families
• Audiologists are generally responsible for follow-up
newborns who fail the initial screen
• Primary Care Manager (PCM) responsible for follow-up
when no audiologist is assigned to a facility
• Good early intervention support system available
through Educational and Developmental Intervention
Services (EDIS) both domestically and overseas
• EHDI services spread out in particular for non US sites
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CDC / NCBDDD / EHDI Briefing
06 Feb 06
• RADM José Cordero, MD, MPH, FAAP
– Director, CDC National Center on Birth Defects
and Developmental Disabilities
– Assistant Surgeon General
• Peter Rzeszotarski, MA
– Acting Associate Director for Policy, Planning,
and Evaluation
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Future Activities
• Continue communication among CDC-EHDI
and all military branches
• Development of a new audiology survey for all
branches (Dr. McCaffrey and Dr. Ryan
expressed interest in collaborating on the
survey)
• Teleconference with the EDIS Program
Manager
• Possible EHDI Special Topics Teleconference
concerning EHDI and the Military
• Offer of resources, materials and training
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American Academy of Pediatrics PediaLink
• Web-based educational program for pediatric
health care professionals
• Modules:
– different types of hearing loss
– screening methods for hearing loss
– medical and genetic risk factors
– the importance of early recognition and
ongoing surveillance
– the role of the medical home in hearing
screening
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American Academy of Pediatrics PediaLink
• CDC-EHDI Free Scholarships for Continuing
Medical Education
(5 AMA PRA Category 1 credits)
• Contact:
– John Eichwald: ‘[email protected]’
– Jill Ackermann: ‘[email protected]
– or: [email protected]’
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Questions?
[email protected]
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The findings and
conclusions in this
presentation have not
been formally
disseminated by the
Centers for Disease
Control and Prevention
and should not be
construed to represent
any agency
determination or policy.