Should Newborn Hearing Screening be the Standard of Care in the United States

1
Issues in Implementing Early Hearing Detection
and Intervention Programs
2
Is Implementation of Universal Newborn
Hearing Screening Accelerating?
If so, why?
,
What issues still need to be addressed?
,
3
Why is Implementation of Newborn
Hearing Screening Accelerating?
Improved Screening
Techniques/Equipment
4
Why is Implementation of Newborn
Hearing Screening Accelerating?
Improved Screening
Techniques/Equipment
Acceptance by
Policy Makers
5
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
)
6
Why is Implementation of Newborn
Hearing Screening Accelerating?
Improved Screening
Techniques/Equipment
Increased Number of
Acceptance by
Successful Programs
Policy Makers
7
Number of Hospitals Doing Universal Newborn
Hearing Screening
Number of Programs
8
Why is Implementation of Newborn
Hearing Screening Accelerating?
Improved Screening
Techniques/Equipment
Acceptance by
Increased Number of
Policy Makers
Successful Programs
Public
Awareness/Demand
9
Implementing Universal Newborn Hearing Screening
Enlisting Support for UNHS
1.
Coordination and Reporting
8.
Selecting an Appropriate
2.
Financing the Program
9.
Protocol
Care of Equipment
10.
Procedural Issues
3.
Diagnosis and Follow-up
11.
Communicating with
4.
Stakeholders
Passing a Legislative
12.
Mandate
Training Screeners
5.
Keeping Refer Rates Low
6.
Managing Data and Patient
7.
Information
10
Enlisting Support for UNHS
Support from authoritative groups
2
Many other hospitals are doing it successfully
2
Has newborn hearing screening already become
2
the standard of care?
Physician support is essential
2
It won't happen without support of the nursing
2
staff
11
Selecting Equipment and Determining an
Appropriate Protocol for Your Hospital
Which equipment is best?
2
12
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13
Selecting Equipment and Determining an
Appropriate Protocol for Your Hospital
Which equipment is best?
2
Wouldn't it be better to wait for the
2
next generation of screening
equipment?
14
Selecting Equipment and Determining an
Appropriate Protocol for Your Hospital
Which equipment is best?
2
Wouldn't it be better to wait for the next
2
generation of screening equipment?
How many tests will be included in the
2
screening protocol?
15
Protocols Used in Universal Newborn
Hearing Screening Programs

Screening Procedures
Before Hospital Discharge

After Hospital Discharge

Number of Programs
TEOAE
TEOAE and ABR
44
DPOAE
DPOAE
5
AABR
AABR
24
AABR
TEOAE
2
TEOAE and ABR
----------
5
TEOAE and AABR
----------
2
DPOAE and ABR
----------
1
TEOAE
----------
4
DPOAE
----------
3
AABR
----------
28
ABR
----------
2
16
Selecting Newborn Hearing Screening
Equipment
AABR
TEOAE
DPOAE
or
or
Cost of equipment
2
Cost of supplies
2
Initial training
2
Time to screen
2
17
Selecting Newborn Hearing Screening
Equipment
(continued)
AABR
TEOAE
DPOAE
or
or
What is being measured?
2
what degree of hearing loss is detected?
4
availability of frequency specific information
4
which parts of auditory pathway are measured?
4
18
Selecting Newborn Hearing Screening
Equipment
(continued)
AABR
TEOAE
DPOAE
or
or
Scoring criteria and ease of interpretation
2
Flexibility of administration
2
Flexibility of use
2
Referral rates
2
19
Selecting Newborn Hearing Screening
Equipment
(continued)
AABR
TEOAE
DPOAE
or
or
Screening in noisy situations
2
False negatives
2
Cost per infant screened
2
20
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?

21
Procedural Issues
Who's in charge?
2
Who will do the screening?
2
Making sure every baby is screened
2
Scoring
2
Should screening be done with the parents
2
present?
22
Communication With Parents
Results of the screening test
2
When to communicate the results
2
What the test really means?
2
Awareness of language development
2
milestones
23
Communication With Physicians
General awareness of the program and its
2
importance
What were the results for their patients?
2
Helping physicians understand the
2
importance of follow up
Medical management issues
2
24
Communication With the Hospital
Recording results in the child's medical
2
record
Documenting the successes and difficulties
2
of the program
Regular reports to hospital administrators
2
Justifying ongoing program support
2
25
Training
Initial training
2
Don't train more people than you need
2
Regular supervision
2
Retraining to accommodate staff turnover
2
26
Keeping Refer Rates Low
Schedule screening when babies are in the best
behavioral state
2
Make a second effort to screen initial fails
prior to discharge
2
Minimize noise and confusion in the screening area
2
Have backup equipment and supplies readily
available
2
You don't need informed consent
2
For OAE procedures, probe fit is critical
2
For Automated ABR procedures, screen when
myogenic activity
2
is low
27
Data and Patient Information
Management
Benefits of computer-based data management
2
Should you design your own, modify an existing,
or purchase a system?
2
2
Safeguarding your data
28
Coordination and Reporting
Data-based program management and
2
refinement
Make people aware of your successes
2
Coordination with early intervention
2
programs
Coordination with other databases
2
29
Financing the Program
How much does it really cost?
2
Will insurance pay for newborn hearing
2
screening?
Is newborn hearing screening cost beneficial?
2
Grants and donations
2
30
Care of Equipment and Supplies
An ounce of prevention is worth a pound of
2
cure
Don't assume people know how to take care of
2
computers
Most hospitals provide computer support--ask
2
for it
31
Diagnosis and Follow up
A good screening program is not necessarily a
good
2
early identification program
Referral to pediatric audiologists
2
Age-appropriate techniques
2
Age at diagnosis
2
Provision of amplification
2
Timely, appropriate, family-centered intervention
is
2
the real goal
32
Legislative Mandates
Is legislation a good idea?
2
Don't wait to start until you have a legislative
2
mandate
What's happening in other states?
2
33
Most Babies Are Already Being Screened.
Do We Really Need a Legislative Mandate?
The last 10 to 20 is the toughest
2
Turnover of key staff or hospital ownership
2
changes
Reporting and Data Management
2
Becoming a part of the Public Health System
2
34
Obtaining a Legislative Mandate
What should the bill contain?
2
Recruiting supporters
2
Negotiating the legislative process
2
When the legislation passes, the work begins
2
35
What Should the Bill Contain?
Strong differences of opinion - - ASHA model is
2
one opinion
Pros and cons of including components in the
2
law versus in Rules and Regulations
Short-term versus long-term strategies
2
Is a bad bill better than no bill?
2
36
Recruiting Support for the Bill
Parents
2
Responsible Executive Agency
2
Physicians
2
Audiologists
2
Hospital Administrators
2
Insurance Industry (public and private)
2
Advocacy Groups
2
Service Clubs (Quota, Lions, Sertoma, etc.)
2
Early Intervention Agency
2
37
Negotiating the Legislative Process
Three most important factors in getting a bill
passed
2
Get the right sponsor
)
Get the right sponsor
)
Get the right sponsor
)
Emotion is more effective than logic
2
Don't fall asleep at the switch
2
It ain't over til it's over
2
38
When the Legislation Passes, the Work Begins
Writing the Rules and Regulations
2
Don't forget who helped you
2
Spreading the word
2
In God we Trust....
2
...from all others, we require data
)
39
Legislation Is Not A Guarantee
In 1990, 16 states had legislative mandates for
newborn hearing screening
2
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
2
Absence of appropriations limits the impact of
many legislative mandates
2
40
3
Status of Universal Newborn Hearing Screening in
the United States
.
Percentage of Births Screened
.
90
51 - 90
21 - 50
1 - 20