Effective Hearing Screening Practices in Health Care Settings Randi Winston, William Eiserman, Lenore Shisler

Partnerships The EAR Foundation of Arizona The Nina Mason Pulliam Foundation –Local funding resource in Arizona –Provided funding for: – program development –11 OAE screeners – implementation of 5 CHC clinics

Partnerships Arizona Association of Community Health Clinics Community Health Centers (CHC's) provide primary health care in rural and medically underserved areas. Health care services offered include Family Practice, Internal Medicine, Pediatric, Obstetrical, Dental and ancillary health care. There are thirty-four not-for-profit, community-based, primary care organizations in Arizona with over 100 sites located throughout the state. Community Health Centers are not-for-profit providers, governed by boards whose members are citizens of the communities they serve. Governed by a system that ensures quality of care is upheld. Centers all over the state catering to underserved populations.

Partnerships National Center for Hearing Assessment and Management Protocol development –based on experience with Hearing Head Start Project Training Materials –Modification of already established training materials Training Process

Rationale for Ongoing Periodic Screening Birth to Three Although all newborns in Arizona are screened at birth, as many as 40% are lost to follow up in between the first and second screens Babies missed in the hospital screening programs Babies born outside of AZ that never had a screen

Rationale for Ongoing Periodic Screening Birth to Three Babies born with risk factors for late onset and progressive losses Babies born with milder forms of losses that were not identified by hospital screening program Infants and children that acquire chronic otitis media

Rationale for Ongoing Periodic Screening Community Health Care Settings High volume clinics Provides a safety net to catch kids that have fallen through the cracks Early childhood screenings are an established part of well-child visits Current screening methods are unreliable New technology makes it feasible for non- audiology staff to conduct screenings Eliminates need for referrals to PCPs thus minimizing steps for follow-up

Protocol Development Objectives C ommunity Health Care Settings Importance of incorporating screening into already established activities Simple, sensible format and guide for screeners and physicians to follow Establishment of no brainer protocols –Periodicity protocols How often should screenings be conducted –Well child visit –JCIH risk indicators for late onset and progressive hearing loss, parental concerns, speech delays, OM –Screening protocols Follow-up on kids not passing OAE

Shisler and Eiserman Hearing Screening Form

Training and Implementation Community Health Care Settings Set up trainings in each of the clinics Meet with physicians –Education –Determine protocols Conduct staff training Data collection to monitor screening outcomes Track reimbursement outcomes

Challenges to Consider Community Health Care Settings Significant time constraints –staff training issues –physician training and education –Environment is often chaotic; difficult to complete screening session on kids that are non- compliant. – completion of recommended screening protocol –keeping track of kids that need follow-up and that need to be screened more often

Challenges to Consider Community Health Care Settings Staff turnover –Physicians –Medical assistants Language barriers Methods often used for middle ear assessment Care coordination methods

Future Developments Funding provided to NCHAM by the Oticon Foundation The Oticon Foundation is currently providing funding to NCHAM to develop physician and staff training materials promoting continuous OAE screening in healthcare settings, including: A video for EHDI Coordinators or others to use when making presentations to physicians. An overview pamphlet/booklet for physicians summarizing the main points and protocol. A set of written and video materials for training medical staff (nurses and medical assistants). Checklists for physicians/staff covering the logistics of implementing continuous OAE screening.

Conclusion Implementations Considerations Data reporting to a central tracking program Coordination of activities related to screening –Program maintenance –Training new staff –Care coordination for follow ups (ensuring families come back for rescreens) Equipment sharing in busy offices Equipment reliability Reimbursement Issues

Conclusion Essential Elements Well trained staff –Physicians and screening staff Screening activities Follow-up and referrals Plan in place for training new staff Program Management Equipment that is dependable Protocol to guide screening activities