Head Start's 'Performance Standards' reflect a long-standin

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Getting a Hearing Head Start
Assessing hearing health. . .
. . . an important piece of the language and
literacy puzzle
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Language Development is at the heart of
Cognitive development
Educational achievement
Language Development
Socialization
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Hearing Health is at the Heart of Language
Development
Cognitive development
Educational achievement
Language Development
Hearing Health
Socialization
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Why is Early Identification of Hearing Loss so
Important?

• Hearing loss occurs more frequently than any
  other birth defect.
• Undetected hearing loss has serious negative
  consequences.
• There are dramatic benefits associated with early
  identification of hearing loss.

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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.
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Identified lt6 mos (n 25)
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Identified gt6 mos (n 104)
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3
Language Age (yrs)
2
1
0
0.8
1.2
1.8
2.2
2.8
3.2
3.8
4.2
4.8
Age (yrs)
Moeller, M.P. (1997).
Personal communication
, moeller_at_boystown.org
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Technological advances in the past 10 years have
made it possible to conduct highly reliable
physiological hearing screening of children as
young as a few hours old. Hearing screening
equipment has become
Advances in Technology

• More affordable
• More portable
• Easier to use

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The National Center for Hearing Assessment
Management (NCHAM) at Utah State University

• NCHAM serves as the Maternal and Child Health
  Bureaus National Technical Assistance system to
  help hospitals, states, and professionals
  implement and improve comprehensive and effective
  Early Hearing Detection and Intervention (EHDI)
  programs.
• Working together, we have achieved significant
  advances in our ability to screen newborns for
  hearing loss.

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Universal Newborn Hearing Screening
Percentage of Newborns Screened for Hearing Prior
to Discharge
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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
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Why is Continuous Hearing Screening so Important?

• As many as 50 of infants who refer from newborn
  hearing screening are lost to follow-up.
• Hearing loss can occur at any time in a childs
  life.
• Approximately 35 of preschool children will have
  repeated ear infections before 3 years of age,
  sometimes resulting in fluctuating conductive
  hearing loss.
• Without regular, physiologic screening, hearing
  loss is often impossible to detect.

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Status of Head Start Hearing Screening Practices

• Head Starts Performance Standards reflect a
  long-standing commitment to hearing screening
  All children are to receive a hearing screen
  within 45 days of enrollment however
• Most Grantees are relying on subjective, outdated
  screening methods such as hand clapping, bell
  ringing, and parent questionnaires to screen
  children 0 3 years of age.
• Most Grantees are unaware that Otoacoustic
  Emissions (OAE) technology, used widely in
  newborn hearing screening programs, can also be
  used successfully in early childhood settings.

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Otoacoustic Emissions (OAE) Screening
OAE Hearing Screening is ideal for screening
young children because it

• Is painless for the child
• Requires no behavioral response
• Is quick and efficient to administer
• Can be performed by anyone skilled in working
  with children and trained to do the procedure
• Can help identify the potential presence of ear
  infections as well as permanent hearing losses

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From 2001 2004, NCHAM has been conducting a
project helping Grantees. . .
The Hearing Head Start Project

• Migrant Head Start
• American Indian Head Start
• Early Head Start

. . . update hearing screening practices for
children 0 - 3 years of age using OAE technology.
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Hearing Head Start Project Participants in UT,
WA, and OR

• Receive training and OAE equipment
• Conduct OAE screening on all children 0 - 3 years
  of age following a prescribed protocol
• Document screening and follow-up outcomes submit
  data on a regular basis
• Receive ongoing technical assistance and linkage
  with additional hearing resources

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The Hearing Head Start Project --Outcomes to
Date

• 104 Migrant, American Indian, and Early Head
  Start staff trained
• Representing 19 grantees (69 program sites) in
  WA, OR, and UT
• Using 36 pieces of OAE equipment
• Almost 3000 children screened

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OAE Screening/Referral Outcomes

• 2851 children screened (using a 3 - step
  screening protocol)
• 171 (6) were referred for medical/audiological
  follow-up

• (63 currently in process to receive initial
  follow-up)
• 59 identified with a hearing loss or disorder
• 8 being monitored/diagnosis unknown
• 19 normal/no treatment required
• 22 lost to follow-up or parent refusal

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OAE Screening/Referral Outcomes

• Of the 59 identified with a hearing loss or
  disorder

• 2 severe, bilateral, sensorineural losses
• 2 mild-moderate, bilateral, permanent conductive
  losses
• 6 bilateral, fluctuating conductive losses
  requiring treatment
• 42 otitis media (ear infection) requiring
  treatment
• 1 treated for occluded Pressure Equalization
  tubes
• 1 treated for perforated eardrum
• 5 treated for excessive ear wax

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Responses from Head Start Programs

• Quick (averages 5 minutes per child), reliable,
  and incurs no additional personnel costs can be
  done by CNAs, health coordinators, disability
  specialists, nursing professionals, home
  visitors, family advocates and other early
  childhood staff
• Builds confidence that their hearing screening
  approach is based on sound audiological practices
• Expedites referral for follow-up contributes
  significantly to the childs Medical Home because
  OAE screening is not currently available in most
  health care provider offices/clinics
• Contributes to community hearing health as
  information is shared with Part C providers,
  Community Health Clinics and health care
  providers.

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Purchasing OAE Equipment is NOT enough for Head
Start Grantees to successfully update hearing
screening practices

• Audiological supervision
• Training
• An appropriate screening follow-up protocol
• Ongoing technical assistance linkage to
  local/state hearing resources

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Without training, audiological supervision and
an appropriate screening protocol, Grantees are
likely to experience problems related to

• Inappropriate selection of/care of screening
  equipment
• High refer rates over-referral to
  physicians/audiologists
• OAE technology misconstrued as a diagnostic tool
• Confusion over the screeners role/limitations
• Under-identification of hearing loss and other
  disorders
• Inappropriate follow-up diagnostic and
  intervention services

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Essential Elements of the Screening Protocol

• Reduces over-referral to physicians/audiologists,
  while promoting timely referral as needed

• Screens for hearing health concerns in the outer,
  middle and inner ear

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Essential Elements of the Screening Protocol

• Screening and Follow-up Forms (provided to
  screeners to document screening results) reflect
  the screening protocol
• Screeners are visually prompted on the correct
  next step in the protocol

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Ongoing Technical Assistance Topics

• Acceptable refer rates how to improve screening
  strategies for screening in homes
• Acceptable modifications to the protocol
  (sometimes needed in remote/rural areas)
• Equipment care and concerns
• Establishing relationships with local
  audiologists and medical providers
• Clarifying the Medical Home concept
• Responding to primary care provider questions
  concerns about the OAE screening
• Reviewing individual cases of children requiring
  re-screening or follow-up
• Understanding follow-up medical/audiological
  recommendations

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Sustainability Replicability
During 2003 2004, NCHAMs Hearing Head Start
Team is working with existing state-based Early
Hearing Detection and Intervention (EHDI)
programs and other stakeholders to

• Establish ECHO Teams that will echo the
  training and technical assistance activities of
  the original Hearing Head Start Pilot Project

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Sustainability Replicability
State-based ECHO teams will

• Sustain and expand early childhood OAE hearing
  screening activities in Oregon, Utah and
  Washington, providing ongoing technical
  assistance to Grantees
• Initiate early childhood OAE hearing screening
  activities in Kansas and North Carolina

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Sustainability Replicability
NCHAM has developed a comprehensive training
package that includes

• Hearing Screening Follow-up Diagnostic Forms
• Getting a Hearing Head Start Updating Early
  Childhood Hearing Screening --Program Screening
  Guide (for Grantees)
• Getting a Hearing Head Start Updating Early
  Childhood Hearing Screening Practices -- Training
  Video (four-part training video reproduced in
  CD-ROM and VHS formats)
• The (((ECHO))) Team Training and Technical
  Assistance Manual -- outlining 14 implementation
  steps for establishing ECHO Teams, collaborating
  with state hearing-health stakeholders, and
  providing training ongoing technical assistance
  to Grantees.

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ECHO Team Preparation
NCHAM provides 2-day training workshop to ECHO
Teams to

• Familiarize ECHO Teams with concepts, materials
  and resources
• Model the training process
• Assist ECHO Teams in developing implementation
  plans

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ECHO Team Activities

• Provide ongoing technical assistance to Grantees
  engaged in OAE screenings
• Provide initial training to at least 5 new
  Grantees
• Provide basic information to all Head Start
  Grantees in the state serving children 0 - 3
  years of age
• Assist in data collection of screening results
• Develop plan for sustainability
• Establish linkages between newborn hearing
  screening and early childhood hearing screening
  activities in the state

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Who can help put the pieces together so that
ALL young children can . . . .
. . . receive the benefit of high-quality, early
and continuous hearing screening???
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WE CAN!
Head Start Regional Offices Head Start State
Collaboration Offices Head Start Technical
Assistance Providers Migrant, American Indian and
Early Head Start Grantees State Early Hearing,
Detection and Intervention (EHDI) Programs
Part C Providers, Community Health Clinics,
Indian Health Services Parents and Professional
Organizations
a 501c(3) non-profit organization working on
behalf of all children and families www.infanthear
ing.org