Issues in Implementing Early Hearing Detection and Intervention Programs
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Transcript of Issues in Implementing Early Hearing Detection and Intervention Programs
Issues in Implementing Early Hearing Detection and Intervention
Programs
If so, why?
What issues still need to be addressed?
Is Implementation of Universal Newborn Hearing Screening Accelerating?
Improved ScreeningTechniques/Equipment
Why is Implementation of Newborn Hearing Screening Accelerating?
Improved ScreeningTechniques/Equipment
Acceptance byPolicy Makers
Why is Implementation of Newborn Hearing Screening Accelerating?
1988: Commission on Education of the Deaf
1990: Healthy People 2000 Report
1993: NIH Consensus Statement
1994: Joint Committee on Infant Hearing
1998: American Academy of Pediatrics
Improved ScreeningTechniques/Equipment
Acceptance byPolicy Makers
Why is Implementation of Newborn Hearing Screening Accelerating?
Increased Number ofSuccessful Programs
Number of Hospitals Doing Universal Newborn Hearing Screening
3 3 11 26 60 120243
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934
1384
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Improved ScreeningTechniques/Equipment
Acceptance byPolicy Makers
Why is Implementation of Newborn Hearing Screening Accelerating?
Increased Number ofSuccessful Programs
PublicAwareness/Demand
Implementing Universal Newborn Hearing Screening
Enlisting Support for UNHS
Selecting an Appropriate Protocol
Procedural Issues
Communicating with Stakeholders
Training Screeners
Keeping Refer Rates Low
Managing Data and Patient Information
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Coordination and Reporting
Financing the Program
Care of Equipment
Diagnosis and Follow-up
Passing a Legislative Mandate
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Enlisting Support for UNHS
Support from authoritative groups
Many other hospitals are doing it successfully
Has newborn hearing screening already become the standard of care?
Physician support is essential
It won't happen without support of the nursing staff
Selecting Equipment and Determining an Appropriate Protocol for Your Hospital
Which equipment is best?
Selecting Equipment and Determining an Appropriate Protocol for Your Hospital
Which equipment is best?
Wouldn't it be better to wait for the next generation of screening equipment?
Selecting Equipment and Determining an Appropriate Protocol for Your Hospital
Which equipment is best?
Wouldn't it be better to wait for the next generation of screening equipment?
How many tests will be included in the screening protocol?
Protocols Used in Universal Newborn Hearing Screening Programs
Screening Procedures
Before Hospital Discharge After Hospital Discharge Number of Programs
TEOAE TEOAE and ABR 44DPOAE DPOAE 5AABR AABR 24AABR TEOAE 2
TEOAE and ABR ---------- 5TEOAE and AABR ---------- 2DPOAE and ABR ---------- 1
TEOAE ---------- 4DPOAE ---------- 3AABR ---------- 28ABR ---------- 2
Selecting Newborn Hearing Screening Equipment
Cost of equipment
Cost of supplies
Initial training
Time to screen
AABR or TEOAE or DPOAE
Selecting Newborn Hearing Screening Equipment (continued)
What is being measured?
AABR or TEOAE or DPOAE
what degree of hearing loss is detected?
availability of frequency specific information
which parts of auditory pathway are measured?
Selecting Newborn Hearing Screening Equipment (continued)
Scoring criteria and ease of interpretation
Flexibility of administration
Flexibility of use
Referral rates
AABR or TEOAE or DPOAE
Selecting Newborn Hearing Screening Equipment (continued)
Screening in noisy situations
False negatives
Cost per infant screened
AABR or TEOAE or DPOAE
Summary: Selecting the Best Newborn Hearing Screening Equipment
• What do you want the equipment to do?
• What is the cost of purchase and use?
• How good is customer support?
Procedural Issues
Who's in charge?
Who will do the screening?
Making sure every baby is screened
Scoring
Should screening be done with the parents present?
Communication: With Parents
Results of the screening test
When to communicate the results
What the test really means?
Awareness of language development milestones
Communication: With Physicians
General awareness of the program and its importance
What were the results for their patients?
Helping physicians understand the importance of follow up
Medical management issues
Communication: With the Hospital
Recording results in the child's medical record
Documenting the successes and difficulties of the program
Regular reports to hospital administrators
Justifying ongoing program support
Training
Initial training
Don't train more people than you need
Regular supervision
Retraining to accommodate staff turnover
Keeping Refer Rates Low
Schedule screening when babies are in the best behavioral state
Make a second effort to screen initial fails prior to discharge
Minimize noise and confusion in the screening area
Have backup equipment and supplies readily available
You don't need informed consent
For OAE procedures, probe fit is critical
For Automated ABR procedures, screen when myogenic activity is low
Data and Patient Information Management
Benefits of computer-based data management
Should you design your own, modify an existing, or purchase a system?
Safeguarding your data
Coordination and Reporting
Data-based program management and refinement
Make people aware of your successes
Coordination with early intervention programs
Coordination with other databases
Financing the Program
How much does it really cost?
Will insurance pay for newborn hearing screening?
Is newborn hearing screening cost beneficial?
Grants and donations
Care of Equipment and Supplies
An ounce of prevention is worth a pound of cure
Don't assume people know how to take care of computers
Most hospitals provide computer support--ask for it
Diagnosis and Follow up
A good screening program is not necessarily a good early identification program
Referral to pediatric audiologists
Age-appropriate techniques
Age at diagnosis
Provision of amplification
Timely, appropriate, family-centered intervention is the real goal
Legislative Mandates
Is legislation a good idea?
Don't wait to start until you have a legislative mandate
What's happening in other states?
Most Babies Are Already Being Screened. Do We Really Need a Legislative Mandate?
The last 10% to 20% is the toughest
Turnover of key staff or hospital ownership changes
Reporting and Data Management
Becoming a part of the Public Health System
Obtaining a Legislative Mandate
What should the bill contain?
Recruiting supporters
Negotiating the legislative process
When the legislation passes, the work begins
What Should the Bill Contain?
Strong differences of opinion - - ASHA model is one opinion
Pros and cons of including components in the law versus in Rules and Regulations
Short-term versus long-term strategies
Is a bad bill better than no bill?
Recruiting Support for the Bill
Parents
Responsible Executive Agency
Physicians
Audiologists
Hospital Administrators
Insurance Industry (public and private)
Advocacy Groups
Service Clubs (Quota, Lions, Sertoma, etc.)
Early Intervention Agency
Negotiating the Legislative Process
Three most important factors in getting a bill passed:Get the right sponsorGet the right sponsorGet the right sponsor
Emotion is more effective than logic
Don't fall asleep at the switch
It ain't over til it's over
When the Legislation Passes, the Work Begins
Writing the Rules and Regulations
Don't forget who helped you
Spreading the word
In God we Trust.......from all others, we require data
Legislation Is Not A Guarantee
In 1990, 16 states had legislative mandates for newborn hearing screening
7 of those had no program
6 of the 9 programs were not state wide
Dpmt of Educ officials in 10 of 16 states unaware legislation existed
Rules and regulations are often as important as legislation
Absence of appropriations limits the impact of many legislative mandates
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Status of Universal Newborn Hearing Screeningin the United States
.Percentage of Births
Screened
90%+
21 - 50%1 - 20%
3
51 - 90%