Success in Minimizing Loss-to-Follow-up Hallie W. Morrow, M.D., M.P.H.

Challenges in California Size Diversity Mobility

Size Population of California 34,000,000 Population of Los Angeles County 9,500,000 Population of Alpine County 1,200

Size 540,000 Births per year 320 Birthing hospitals Largest – 7300 deliveries Smallest – 60 deliveries

Diversity Geographic Race/ethnic Linguistic

Geographic Diversity Large metropolitan areas

Geographic Diversity Large metropolitan areas Agricultural areas

Geographic Diversity Large metropolitan areas Agricultural areas Mountains

Geographic Diversity Large metropolitan areas Agricultural areas Mountains Desert

Geographic Diversity Large metropolitan areas Agricultural areas Mountains Desert Coastal

Race/Ethnic Diversity 47% Non-Hispanic White 32% Hispanic 11% Asian/Pacific Islander 6% African American 1% American Indian 3% Other

Linguistic Diversity 33% of Californians speak a language other than English in the home 20% of Californians have Limited- English-Proficiency 50% of low-income Californians have a primary language other than English.

Linguistic Diversity 1,570,000 students speak a language other than English in the home 105 languages are spoken in Fresno County schools

Mobility Urban Migrant workers Mexican border

Infrastructure

Interwoven with the Title V CSHCN and the EPSDT programs Inpatient and outpatient provider standards Hearing Coordination Centers Single point of referral to IDEA Part C

Hearing Coordination Centers Serve specific geographic areas Certify and re-certify hospitals as meeting standards Collect data Track appointments for individual infants

Hearing Coordination Centers Contact providers if no results are received Refer to local EPSDT program if infant no shows appointments or provider cannot contact the family

Hearing Coordination Centers Generate correspondence to infants PCP Contact all families of infants identified with hearing loss

Hearing Coordination Centers Assure referral to EI has been made Quality assurance monitoring

Referral to Early Intervention Created single point of referral for all California children 0-3 years of age with a hearing loss

Data Management No statewide data management system Each HCC developed Access database All infant information and results reported on paper reporting forms

California Program Data 2004 (Preliminary) 175 Hospitals participating

California Program Data 2004 (Preliminary)

Summary Infrastructure! Receive and review individual infant data in real time Take action if not getting appropriate services