1. First Annual National EHDI Meeting
Panel on Operating Effective Screening Programs
South Carolina
Jane Lukshis, MN, RN
Nurse Consultant- DHEC
Division of Children with Special Health Care Needs

2. Because Babies Can’t Tell Us If They Can’t Hear
Count Their Fingers Count Their Toes Test Their Hearing
Because Babies Can’t Tell Us If They Can’t Hear

3. Background-1996 Conducted a needs assessment specific to
SC and results were consistent with
national findings:
 Hospitals were only screening newborns with
risk indicators (2 hospitals were screening all newborns)
 Average age of identification was 2 ½ to 3 years
of age
  Limited number of audiologists providing services to infants identified with a hearing loss

4. Established statewide Advisory Council
January – July, 1997
Established statewide Advisory Council
DHEC- serve as Lead Agency
SC Perinatal Association
Audiologists
SC Department of Education
Early Intervention Programs
Title V and Part C Programs
SC School for the Deaf and Blind

5. Established statewide Advisory Council
January – July, 1997 (cont.)
Established statewide Advisory Council
Governor’s Office
Speech-Language Pathologists
Neonatologists
Otolaryngologists
Pediatricians
AG Bell
Bureau of Health Licensing- DHEC
South Carolina Medical Association

6. Established statewide Advisory Council
January – July, 1997 (cont.)
Established statewide Advisory Council
DHHS- Medicaid program
USC Schools of Public Health & Medicine
SC Academy of Audiologists
SC Association of the Deaf
SC Hospital Association
SC State Office of Rural Health
Nursery staff
Parents of children with hearing loss

7. Created 4 subcommittees from the Advisory Council
January – July, 1997 (cont.)
Created 4 subcommittees from the Advisory Council
Tracking and Data Management- responsible for developing hospital screening and audiology evaluation forms; and tracking methods
 Funding- responsible for exploring payment/reimbursement options for in-patient screens and audiologic follow-up

8. Created 4 subcommittees from the Advisory Council
January – July, 1997 (cont.)
Created 4 subcommittees from the Advisory Council
 Education- responsible for developing public awareness and educational materials
 Early Intervention- responsible for assessing SC’s capacity to provide services for infants identified with a hearing loss

9. Implemented Pilot Project
August December 1999:
Implemented Pilot Project
 8 hospitals volunteered to participate (represented 24% of annual births statewide)
 ABR or AABR technology used for in-patient screens
 Hospital screening and audiology evaluation forms sent to DHEC for tracking purposes

10. Level I
Level II
Level III

11. Data analysis of pilot Revisions in the hospital protocols,
introduction of an electronic data
monitoring and tracking system, and
referrals to Family Support Services
resulted in a 99.9% capture rate,
referral rate <4%, and 6% lost to
follow-up.

12. January 2000-June 2001
Developed a work plan to implement statewide early hearing detection and intervention
 Intensified our collaborative efforts with SC Hospital Association
 Arranged for NATUS and Pediatrix, Inc. to
provide technical assistance
 Met with representatives from all 48 birthing centers and conducted a “readiness”
assessment

13. January 2000-June 2001 (cont.)
 Outlined which hospitals on a monthly basis
we would bring on board
 Funded legislation was passed in June, 2000
mandating that newborn hearing screening prior
to hospital discharge be conducted in hospitals
with at least 100 births annually beginning
July, 2001

14. January 2000-June 2001 (cont.)
 Contracted with a consulting firm to develop
an Internet based data entry and tracking system
 Developed First Sound brochure (available in
English and Spanish)
 Completed statewide implementation in May, 2001

15. AAP and JCIH recommendations
Data analysis 1/00-6/01
Benchmarks
AAP and JCIH recommendations
First Sound
Capture Rate
95%
98%
Audiology follow up
80% with audiology f/u
20% without audiology f/u
Referral Rate
< 4%
2.1%
False positive rate
< 3%
1.9%
HL identified by 3 months of age
“strive for 100%”
<3 months= 65%
3-6 months= 27%
> 6 months = 8%
Early intervention by 6 months
60% known to Part C
90% of those enrolled within 6 months of confirmed HL

16. Infants with confirmed hearing loss: n= 84

17. Confirmed HL with risk factors

18. Laterality of confirmed hearing loss

19. Right Ear versus Left Ear (all confirmed hearing loss)

20. Types of hearing loss (all confirmed hearing loss)

21. Degrees of hearing loss( all confirmed hearing loss)

22. Unilateral- types of hearing loss

23. Unilateral- degrees of hearing loss

24. Bilateral- types of hearing loss

25. Bilateral- degrees of hearing loss

26. July 2001 to present Funded legislation effective July, 2001
All 48 birthing centers are screening newborns prior to discharge and submitting data electronically to DHEC
Statewide implementation of Internet based application in progress, to include access and entry by hospitals, audiologists and PCP

27. July 2001 to present
Completed a statewide PR campaign in December, 2001 which included PSAs and bill boards
Full time Program Manager, Program Coordinator and Data Manager
Continue to provide trainings, in-services and oversight for hospitals and audiologists
Strengthened our links with other programs to ensure follow up activities occur from hospital screening through early intervention