Measuring Benchmarks and Quality Indicators for Early Intervention Dawn M. O’Brien, M.Ed. EI/ECSE Nannette C. Nicholson, Ph.D. CCC-A Judith E. Widen, Ph.D. CCC-A

Introduction Local State Federal

Kansas 105 Counties 37 Networks –Leavenworth County Infant- Toddler Services: tiny-k program

Background Performance Measures –Principles –Benchmarks –Quality Indicators JCIH Position Statement

Focus Joint Committee on Infant Hearing 2000 Position Statement –Principle 3 – Early Intervention Six Benchmarks Ten Quality Indicators –Principle 8 Data collection

Benchmarks for Early Intervention 1.Enrolled prior to 6 months of age 2.Professional personnel & communication options 3.Use of amplification within one month of confirmation of hearing loss

Benchmarks for Early Intervention 4.Audiologic monitoring not to exceed three months 5.Language is developmentally appropriate 6.Family demonstrate self-advocacy

Matching Benchmarks & Quality Indicators Percentage of infants before 6 months of age Percentage…with professional personnel who are knowledgeable 1.Enrolled prior to 6 months of age 2. Professional personnel & communication options

Matching Benchmarks & Quality Indicators 3.Use of amplification within one month of confirmation Percentage of infants with who begin use of amplification within one month of confirmation of the hearing loss

Matching Benchmarks & Quality Indicators 4.Audiologic monitoring not to exceed three months Percentage … receive monitoring at intervals not to exceed 3 mo. Number of follow-up visits in the first year

Matching Benchmarks & Quality Indicators 5. Language is developmentally appropriate Percentage of language evaluations every 6-months Percentage of infant’s language equal to hearing peers Percentage of achieved outcomes on IFSP

Matching Benchmarks & Quality Indicators 6.Family demonstrates self-advocacy Percentage of families who refuse EI Percentage of families who participate in and express satisfaction with self-advocacy

Problem Who is responsible for reporting data? Is the information available? If so, where is the information located?

Question? Does our network collect the data necessary to report information to the state on Benchmarks and Quality Indicators for Early Intervention?

Method Subject Selection –Criteria –Population Procedure –Matching Benchmarks and Quality Indicators –Database Design –Retrospective Chart Review

Subject Selection Criteria Birth to three Enrolled in Early Intervention in Leavenworth County after 1999 Hearing loss greater than 20 HL dB bilaterally

Population 260 (1999 – 2003) Part C Eligible Infants and Toddlers –5 children diagnosed with >20 dB hearing loss sensorineural or conductive 4 actively followed by an audiologist and early intervention

Matching Benchmarks & Quality Indicators Percentage of infants before 6 months of age Percentage…with professional personnel who are knowledgeable 1.Enrolled prior to 6 months of age 2.Professional personnel & communication options

Calculating Quality Indicators 1.Percentage of infants with hearing loss who are enrolled … before 6 months of age a.# < 6 months/# HL in program

Database Design 1.Enrolled prior to 6 months of age a.Date of birth b.Date of enrollment (referral date)

Retrospective Chart Review Intake Form Individual Family Service Plans Audiology reports Speech language evaluation reports Speech evaluation test forms Progress notes Anecdotal notes

Results 1.Percent enrolled prior to 6 months of age (60%) –Child 1 = 2 mo –Child 2 = 2 mo –Child 3 = 13 mo –Child 4 = 11.5 mo –Child 5 = 1 mo

Results 2.Professional personnel & communication options Not included in this study

Results 3.Percent use of amplification within one month of confirmation (0%) Child 1 = 3/01-6 mo + Contraindication Child 2 = 3/01 - no hearing aid fit date Child 3 = no ABR date/hearing aid fit date Child 4 = 4/01 - no hearing aid fit date Child 5 = Soundfield AC/ no hearing aids

Results 4.Percent of infants …audiologic monitoring not to exceed three months (0%) Child 1 = 9/01, 12/01, 6/02, 10/02, 11/02 Child 2 = no hearing aid fit date Child 3 = no hearing aid fit date Child 4 = no hearing aid fit date

Results 4.Number of follow-up visits in the first year –Child 1 = 2 Visits –Child 2 = no hearing aid fit date –Child 3 = no hearing aid fit date –Child 4 = no hearing aid fit date

Results 5.Percent of children with language evaluations every six months (0%) –Child 1 = 3/01, 10/01, 4/02 –Child 2 = 3/01 –Child 3 = 4/02, 12/02 –Child 4 = 2/03

Results 5.Percent of infants with language equal to hearing peers (0%) –Unable to determine

Results 5.Percent of achieved IFSP outcomes (0%) Child 1 = not met Child 2 = not met Child 3 = not recorded Child 4 = not recorded

Results 6.Family self-advocacy –Refusal Not included in study –Express satisfaction with self advocacy Not included in study

Conclusion Depends on the communication between the early intervention program and the audiologist Standard data collection methods should be established

The End

Database Design 1.Enrolled prior to 6 months of age a.Date of birth b.Date of enrollment (referral date)

Database Design 2.Professional personnel & communication options a.Information is not available in chart

Database Design 3.Use of amplification within one month of confirmation a.Date of ABR b.Documented medical contraindication c.Date of medical clearance d.Documented family consent e.Date of hearing aid fit

Database Design 4.Audiologic monitoring not to exceed three months a.Date of hearing aid fit b.Date of each audiology contact documentation in the child’s file

Database Design 5.Language is developmentally appropriate a.Date of birth b.Date of each language evaluation c.Corresponding developmental level d.Corresponding language age e.Achieved IFSP outcomes

Database Design 6.Family self-advocacy a.Information is not available in chart