Transcript Jane Lukshis (South Carolina)

First Annual National EHDI
Meeting
Panel on Operating Effective Screening Programs
South Carolina
Jane Lukshis, MN, RN
Nurse Consultant- DHEC
Division of Children with Special Health Care Needs
Count Their Fingers
Count Their Toes
Test Their Hearing
Because Babies Can’t Tell Us If They Can’t Hear
Background-1996

Conducted a needs assessment specific to
SC and results were consistent with
national findings:
 Hospitals were only screening newborns with
risk indicators (2 hospitals were screening all newborns)
 Average age of identification was 2 ½ to 3 years
of age
 Limited number of audiologists providing services to
infants identified with a hearing loss
January – July, 1997

Established statewide Advisory Council
DHEC- serve as Lead Agency
 SC Perinatal Association
 Audiologists
 SC Department of Education
 Early Intervention Programs
 Title V and Part C Programs
 SC School for the Deaf and Blind

January – July, 1997 (cont.)
Established statewide Advisory Council
 Governor’s Office
 Speech-Language Pathologists
 Neonatologists
 Otolaryngologists
 Pediatricians
 AG Bell
 Bureau of Health Licensing- DHEC
 South Carolina Medical Association

January – July, 1997 (cont.)
Established statewide Advisory Council
 DHHS- Medicaid program
 USC Schools of Public Health & Medicine
 SC Academy of Audiologists
 SC Association of the Deaf
 SC Hospital Association
 SC State Office of Rural Health
 Nursery staff
 Parents of children with hearing loss

January – July, 1997 (cont.)
Created 4 subcommittees from the
Advisory Council
Tracking and Data Management- responsible
for developing hospital screening and audiology
evaluation forms; and tracking methods
 Funding- responsible for exploring
payment/reimbursement options for in-patient
screens and audiologic follow-up

January – July, 1997 (cont.)
Created 4 subcommittees from the
Advisory Council
 Education- responsible for developing public
awareness and educational materials
 Early Intervention- responsible for assessing
SC’s capacity to provide services for infants
identified with a hearing loss

August 1997- December 1999:

Implemented Pilot Project
 8 hospitals volunteered to participate
(represented 24% of annual births statewide)
 ABR or AABR technology used for in-patient
screens
 Hospital screening and audiology evaluation
forms sent to DHEC for tracking purposes
Level I
Level II
Level III
Data analysis of pilot
Revisions in the hospital protocols,
introduction of an electronic data
monitoring and tracking system, and
referrals to Family Support Services
resulted in a 99.9% capture rate,
referral rate <4%, and 6% lost to
follow-up.
January 2000-June 2001
Developed a work plan to implement
statewide early hearing detection and
intervention
 Intensified our collaborative efforts with SC
Hospital Association
 Arranged for NATUS and Pediatrix, Inc. to
provide technical assistance
 Met with representatives from all 48 birthing
centers and conducted a “readiness”
assessment

January 2000-June 2001 (cont.)
 Outlined which hospitals on a monthly basis
we would bring on board
 Funded legislation was passed in June, 2000
mandating that newborn hearing screening prior
to hospital discharge be conducted in hospitals
with at least 100 births annually beginning
July, 2001
January 2000-June 2001 (cont.)
 Contracted with a consulting firm to develop
an Internet based data entry and tracking system
 Developed First Sound brochure (available in
English and Spanish)
 Completed statewide implementation in May,
2001
Data analysis 1/00-6/01
Benchmarks
AAP and JCIH
recommendations
First Sound
Capture Rate
95%
98%
Audiology follow
up
95%
Referral Rate
< 4%
2.1%
False positive
rate
< 3%
1.9%
HL identified by
3 months of age
“strive for 100%”
<3 months= 65%
 3-6 months= 27%
 > 6 months = 8%
Early
intervention by 6
months
“strive for 100%”
60% known to Part C
 90% of those enrolled
within 6 months of
confirmed HL
80% with audiology f/u
 20% without audiology
f/u


Infants with confirmed hearing
loss: n= 84
(67.9%)
No risk factors
Risk factors
(32.1%)
Confirmed HL with risk factors
10
Ototoxic meds
8
Low APGAR/asphyxia
LBW
6
Cong. infection
Craniofacial anom.
4
Mechanical vent.
Genetic syn.
2
Family hx
Hyperbilirubinemia
0
Laterality of confirmed hearing
loss
(27.7%)
Unilateral
Bilateral
(72.3%)
Right Ear versus Left Ear (all
confirmed hearing loss)
(30.4%)
Right Ear
Left Ear
(69.6%)
Types of hearing loss (all
confirmed hearing loss)
(24.1%)
Conductive
SN
Mixed
(53.0%)
(10.8%)
(3.6%)
(8.4%)
AN
Not reported
Degrees of hearing loss( all
confirmed hearing loss)
(28.4%)
Slight
Mild
(7.4%)
(22.2%)
Moderate
Mod. sev.
Severe
Profound
(14.8%)
(4.9%)
(11.1%)
(11.1%)
Not reported
Unilateral- types of hearing
loss
(22.7%)
Conductive
SN
(54.5%)
AN
Not reported
(18.2%)
(4.5%)
Unilateral- degrees of hearing
loss
(27.3%)
Slight
(4.5%)
(13.6%)
Mild
Moderate
(4.5%)
Mod. sev.
Severe
Profound
Not reported
(18.2%)
(22.7%)
(9.1%)
Bilateral- types of hearing loss
(25.0%)
Conductive
SN
Mixed
(53.3%)
(8.3%)
AN
Not reported
(3.3%)
(10.0%)
Bilateral- degrees of hearing
loss
(31.0%)
Slight
Mild
Moderate
(3.4%)
(29.3%)
Mod. sev.
Severe
(10.3%)
Profound
Not reported
(12.1%)
(6.9%)
(6.9%)
July 2001 to present



Funded legislation effective July, 2001
All 48 birthing centers are screening
newborns prior to discharge and
submitting data electronically to DHEC
Statewide implementation of Internet
based application in progress, to include
access and entry by hospitals, audiologists
and PCP
July 2001 to present




Completed a statewide PR campaign in
December, 2001 which included PSAs and bill
boards
Full time Program Manager, Program
Coordinator and Data Manager
Continue to provide trainings, in-services and
oversight for hospitals and audiologists
Strengthened our links with other programs to
ensure follow up activities occur from hospital
screening through early intervention