The Impact of the Lack of Early Intervention for Infants with Hearing Loss - PowerPoint PPT Presentation

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The Impact of the Lack of Early Intervention for Infants with Hearing Loss

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The Impact of the Lack of Early Intervention for Infants with Hearing Loss Donna C. Maselli, RN, MPH Connecticut Department of Public Health Hartford, CT – PowerPoint PPT presentation

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Title: The Impact of the Lack of Early Intervention for Infants with Hearing Loss


1
The Impact of the Lack of Early Intervention for
Infants with Hearing Loss
  • Donna C. Maselli, RN, MPH
  • Connecticut Department of Public Health
  • Hartford, CT

2
Faculty Disclosure Information
  • In the past 12 months, I have not had a
    significant financial interest or other
    relationship with the manufacturer(s) of the
    product(s) or provider(s) of the service(s) that
    will be discussed in my presentation.
  • This presentation will not include discussion
    of pharmaceuticals or devices that have not been
    approved by the FDA.

3
Newborn Hearing Screening History in CT
  • Legislation to screen high risk infants since
    1985
  • Primarily NICU babies
  • Well babies were not routinely screened
  • Half the children with PCHL do not exhibit risk
    factors (NCHAM, 2002)
  • 1994 Strong lobbying began to implement Universal
    Newborn Hearing Screening (UNHS)
  • CT Newborn Hearing Screening Task Force formed

4
CT Legislation
  • 19a-59 amendment in part reads.
  • Institutions providing childbirth services
    shall, no later than July 1, 2000, include a UNHS
    program as part of its standard of care.
  • Initial legislation was for July 1, 1999
  • Source Connecticut State Statutes

5
Purpose of UNHS
  • To provide early hearing detection intervention
    (EHDI) to infants, in an attempt to minimize
    speech and language delays
  • EHDI and treatment before 6 months of age
    facilitate a childs healthy development
    consistent with age and cognitive ability

6
Program Goals
  • Hearing screening at birth, before discharge
  • Diagnostic testing within 2 months of initial
    screen
  • Referral to Early Intervention (Birth-to-Three)
  • by 4 months

7
Screening Methods
  • First screen
  • May be Otoacoustic emissions (OAE) or Automatic
    Brainstem Response (ABR)

8
Second Screening
  • Second Screen
  • Repeated before discharge if infant does not pass
    the first screen
  • ABR screen
  • 1/06 ABR screening for all NICU infants

9
2004 STATISTICS
Total Screened 97
Passed 1st Screening 91.21
Passed 2nd Screening 6.37
Referred for Diagnostic Testing 1.35 (n324)
Received Diagnostic Testing 84
Lost to Follow-up 16
Hearing Loss 0.14 (n60)
10
Types of Hearing Loss Identified 2004
Bilateral Unilateral
Conductive 9 21
Sensorineural 54 37
Undetermined 36 47
11
Diagnostic Testing Centers
  • DPH Identified Centers for Follow-up Testing
  • Used CT UNHS Task Force Best Practice Standards
  • Surveyed all CT licensed audiologists
  • Identified 16 Diagnostic Testing Centers
  • Mechanism to report to DPH
  • Referral to E.I.

12
Best Practice Recommendations for Diagnostic
Hearing Testing of InfantsCT Newborn Hearing
Screening Task Force
  • Auditory Brainstem Response ABR (a.k.a BAERS,
    BAER)
  • Threshold measurement with frequency specific
    tone bursts
  • Threshold measurement with bone conduction ABR
  • Sedation in a medical facility where the child
    can be appropriately monitored
  • Immittance Testing
  • Tympanometry with high frequency probe tone
    greater than 1000 Hz
  • Acoustic reflex testing
  •  

13
Best Practice Standards cont
  • Completed by 2 months of age
  • Conducted by a pediatric audiologist
  • A battery of tests based on
  • Screening results
  • Medical history
  • Risk factors
  • Include an otological evaluation
  • May be conducted at different facility and time
  •  

14
Best Practice Standards cont
  • Otoacoustic Emissions (OAE)
  • Transient evoked or distortion product
  •  Behavioral Audiometry
  • May be useful in addition to the above
  • Reporting of results to DPH
  • Refer to Birth-to-Three

15
Degree of Hearing loss
  • Mild 26-40 dB HL
  • Moderate 41-60 dB HL
  • Severe 61-80 dB HL
  • Profound 80

16
AGE AT DIAGNOSIS (in months)National Goal 3
months
YEAR AGE in MONTHS
2000 1.69
2001 3.07
2002 1.74
2003 0.85
2004 2.29
2005 2.92
17
AGE AT Referral to B23 (in months)National Goal
6 months
YEAR CT AGE At Referral
2000 2.13
2001 3.48
2002 2.64
2003 3.23
2004 3.83
2005 4.68
18
Early Intervention Services in CT
  • Mandated reporting (CT General Statutes Sec.
    17a-248d)
  • Report within 2 days of identifying child
  • Suspected or at risk of having developmental
    delay
  • Infants referred through Child Development
    Infoline

19
CT Early Intervention Eligibility
  • Birth-to-Three Eligibility
  • 40db or greater, bilateral hearing loss
  • Exclusions!
  • www.birth23.org
  • 27 states that have language in their legislation
    that includes either unilateral, mild or "any"
    hearing loss

20
Why is early intervention important for children
with mild or unilateral hearing loss?
21
Mild Hearing Loss
  • Will miss 25-40 of what is said 50 in noisy
    situation
  • May not hear consonants such as /s/, /f/, /th/,
    /p/, /h/, /g/, /ch/, /sh/, /z/, /v/
  • Cannot hear plurals or contractions
  • Unable to learn incidental learning common
    sense
  • 37 with slight-mild hearing loss fail a grade,
    typically 1st (Bess et. AL. 1998)

22
Unilateral Hearing Loss
  • Difficulty hearing speech if speaking from behind
    or with background noise
  • Difficulty localizing speech
  • 35 fail one or more grades, typically 1st
  • 27 ages 1-3 present with language delay

23
Attempts to Change CT Birth-to-Three Eligibility
  • To include unilateral and bilateral with any
    degree
  • Multi level support
  • DPH, DSS, UNHS Task Force, Dx Centers
  • Birth-to-Three Medical Advisory meeting
  • Show us the data that says these kids would
    benefit from E.I.

24
The Impact of the Lack of Early Intervention
for Infants with Hearing Loss
  • MD/MPH Student Internship at DPH (Summer 2005)
  • Purpose of the Study
  • Assess speech/language developmental outcomes of
    children with hearing loss who did not receive
    Birth-to-Three services
  • Hypothesis
  • Children with hearing loss who did not receive
    E.I. services will show evidence of delayed
    speech/language by ages 3, 4 or 5 years

25
Methodology
  • Selection Criteria
  • Used UNHS data
  • Infants born between 7/1/00 - 12/31/03
  • Now 2-5 years old
  • 80 of the childs ability to learn speech,
    language and related cognitive skills is
    established by 36 months (White, 2000)
  • Bilateral with mild in at least one ear
  • Unilateral, moderate to profound hearing loss

26
Methodology
  • 94 Records met criteria
  • Letters sent to families
  • Requested parental consent to review audiology
    records
  • 22 consents received
  • Records reviewed for
  • Parental concern
  • An assessment of speech/language
  • Referral for speech evaluation
  • Referral to B23

27
Results
  • 77.3 Recommended ENT consultation
  • 59 No documented audiology visit after ENT
  • 68.2 No documented audiology visit after age 2
  • 90.9 Status of speech/language development
    unknown
  • 9.1 Had documented delay

28
Conclusion
  • Unable to ascertain if lack of early intervention
    is associated with speech/language delays due to
  • Lack of Audiology visit after ENT referral (59)
  • Lack of reference to speech/language in audiology
    record (90.9)
  • Lack of documented follow-up after age 2 (68.2)
  • The absence of visits after age 2 may be due to
  • PCP conducts the screenings in the office
  • Family moved from the region
  • The child is not receiving any care
  • Audiological assessments are being performed by
    the ENT

29
So What Do We Do?
  • ENTs
  • Presented findings at annual ENT Association
    meeting
  • Decrease numbers of undetermined type
  • Encourage collaboration between diagnosing
    audiologist, PCP and ENT
  • Implemented ENT Reporting to DPH

30
So What Do We Do?
  • Audiologists
  • Presented findings at Hearing Screening Symposium
  • Addressed need for speech/language assessment
    along with audiological testing
  • Revised reporting form to collect name of ENT
  • Encouraged better medical home collaboration

31
So What Do We Do?
  • Families
  • Can contact study families to assess follow-up
  • Ascertain if parental concern
  • Confirm audiological follow-up
  • Implementing Listen Learn Program
  • Q 6 mo. Follow-up for infants not eligible for
    E.I.
  • Speech/language assessment
  • Parental education
  • Hearing evaluation

32
(No Transcript)
33
Donna C. Maselli, RN, MPHAmy Mirizzi, MPH
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