Transcript AAP Screening-ScreenMaterials

Early Hearing Detection
and Intervention (EHDI)
~ Challenges and Opportunities ~
Why is early identification of
hearing loss so important?

Hearing loss occurs more frequently
than any other birth disorder.
Incidence per 10,000 of
Congenital Disorders/Diseases
40
30
30
20
5
6
10
11
12
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Why is early identification of
hearing loss so important?

Hearing occurs more frequently than any
other birth disorder.

Undetected
hearing loss
has serious,
negative
consequences.
Reading Comprehension Scores of
Hearing and Deaf Students
Grade Equivalents
10.0
9.0
8.0
7.0
6.0
Deaf
Hearing
5.0
4.0
3.0
2.0
1.0
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.
Why is early identification of
hearing loss so important?

Hearing occurs more frequently than any
other birth disorder.

Undetected hearing loss has serious
negative consequences.

There are dramatic benefits associated with
early identification of hearing loss.
Benefits of Early Identification
Boys Town National Research Hospital Study of Earlier vs. Later
129 deaf and hard-of-hearing children assessed 2x each year.
Assessments done by trained diagnostician as normal part of early intervention program.
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
Age (yrs)
Moeller, M.P. (1997). Personal communication, [email protected]
4.2
4.8
NIH Consensus Panel
Early Identification of Hearing Impairment in Infants
and Young Children
March, 1993
The consensus panel concluded that all
infants should be screened for hearing
Impairment. . .this will be accomplished most
efficiently by screening prior to discharge
from the well-baby nursery. Infants who fail
. . .should have a comprehensive hearing
evaluation no later than 6 months of age.
EHDI Program Goals
▣
All infants will be screened for hearing loss at birth or before
1 month of age.
▣
Infants not passing the screening will receive appropriate
audiologic and medical evaluation before 3 months of age.
▣
Infants and their parents will be linked with a medical home
and culturally competent family support.
▣
All infants with confirmed permanent hearing loss will begin
receiving early intervention services before 6 months of age.
▣
Statewide data and tracking systems will be established to
monitor the quality of screening services and to help ensure that
children and families receive the follow-up services they need.
EHDI Program Components
▣ Universal Newborn Hearing Screening
▣ Medical Home
▣ Diagnostic Audiology
▣ Early Intervention
▣ Family Support
▣ Tracking and Data Management
▣ Universal Newborn Hearing Screening –
Technology
Technological
advances have made it
possible to conduct
highly reliable
physiological hearing
screening of children
as young as a few
hours old.
AABR (Automated Auditory Brainstem
OAE (Otoacoustic Emissions)
Response)
▣ Universal Newborn Hearing Screening
90.0%
Percentage of Newborns Screened for
Hearing Prior to Discharge
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
Jan-03
Jan-02
Jan-01
Jan-00
Jan-99
Jan-98
Jan-97
Jan-96
Jan-95
Jan-94
Jan-93
0.0%
▣ Universal Newborn Hearing Screening
37 States Have Legislative Mandates
Related to Universal Newborn Hearing Screening
States with mandates
No mandate,
but statewide programs
No mandate
▣ Universal Newborn Hearing Screening Legislation
▣ Universal Newborn Hearing Screening
+ There are hundreds of excellent universal
newborn hearing screening programs operating
nationwide.
+ With almost 90% of all babies being screened
prior to discharge, newborn hearing screening is
becoming the accepted standard of care.
- Many programs are still struggling with high
refer rates and poor follow-up.
▣ Universal Newborn Hearing Screening
1999
(n=43,547)
2000
(n=46,771)
2001(6 mos.)
(n=23,307)
Inpatient Pass Rates (state average)
10 most effective hospitals
10 least effective hospitals
85.2%
92.8%
70.7%
85.5%
93.4%
63.4%
87.5%
93.7%
74.4%
Outpatient completion (state average)
10 most effective hospitals
10 least effective hospitals
70.1%
94.5%
45.3%
67.1%
95.9%
52.9%
68.3%
94.7%
58.08%
165 of 380
43.4%
41 of 110*
40%
Reported Completion of Diagnostic
Evaluations (state average)
133 of 357
37.3%
*based on only 3 months of available data
▣ Medical Home
A primary care physician
provides care which is:
•
Accessible
•
Family-centered
•
Comprehensive
•
Continuous
•
Coordinated
•
Compassionate
•
Culturally effective
Birthing
Hospital
Parent Groups
Audiology
Mental Health
Primary
Provider
3rd Party
Payers
ENT
Child/Family
Deaf
Community
Services for
Hearing Loss
Early
Intervention
Programs
Genetics
▣ Medical Home – Primary Care Provider
Education
▣ Medical Home – Strategies for Improving
Follow-up
▣ Medical Home – Follow-up
▣ Diagnostic Audiology
+ Equipment and techniques for diagnosis of
hearing loss in infants continues to improve
+ States are
developing
guidelines to identify
audiologists who can
appropriately serve
infants and young
children
▣ Diagnostic Audiology
-
Severe shortages in experienced pediatric
audiologists delays confirmation of hearing loss
-
State EHDI Coordinators estimate only 56.1%
receive diagnostic evaluations by 3 months of age
▣ Early Intervention
+ Some families are experiencing the benefits
of early identification and intervention
▣ Early Intervention
-
Only 53% of infants with hearing loss are enrolled in EI
programs before 6 months of age
-
Only 31% of states have adequate range of choices for EI
programs
-
Current system designed
to serve infants with
bilateral severe/profound
losses---but, majority of
those identified have mild,
moderate, and unilateral
losses
▣ Family Support
Common emotions of families upon learning that their
child has a hearing loss:
•
(grief) Reactions to
unexpected diagnosis
• (pressure) Urgency of
communication decisions
▣ Family Support
Common emotions of families upon learning that their
child has a hearing loss:
•
(confusion) Search for
experienced professionals
• (isolation) Availability of
services and support
▣ EHDI Data Management, Tracking and
Follow-up
+ 75% of states receive
screening data from
some hospitals -information submitted
for 62% of births in
2001
- 33% of submissions have no identifying data
-making follow-up by state EHDI staff impossible
- Only 17% of states currently have any kind of
linkage with other data systems (eg, Vital
Statistics, Heelstick, EI, Immunizations)
▣ Where do we go from here?