1. Can You Hear Me Now? What is the best way to identify potential Hearing & Vision issues? MDCH can help. Early On Webinar - June 20, 2013 Tiffany Kostelec, MDCH Consultant for Early On Jennifer Dakers, MDCH Hearing Consultant Dr. Rachel Schumann, MDCH Vision Consultant Dr. Michelle Garcia, MDCH EHDI Loss to Follow-up Consultant

2. Why are we here?  MDE purchased OAE and Sure Sight screening equipment in 2003 Intent – provide objective screening that results in valid & reliable hearing and vision status. Prevent – late identified hearing & vision problems. Subjective screening (paper & pencil questionnaire) only i.d. 50% of those with problems.  Update new staff/Refresh previously trained staff.  Trends in Use/Non-Use Repair Issues Troubleshooting Issues Calibration Issues Training Issues

3. Overview of Webinar.  MDCH Hearing and Vision screening Program Equipment. Is screening important? Available trainings. Let’s work together.  MDCH EHDI Program. What is EHDI? EHDI National and State goals EHDI stats. How can you help?

4. What Is A Screening? Screening is the first step in identifying infants and toddlers that may have a hearing or vision loss

5. Michigan Department of Community Health: Hearing Program

6. Public Act 368 of 1978, Part 93 Hearing and Vision Rules R325.3274 – Frequency of Screening  Rule 4. (1) Hearing and vision screening of preschool children shall be done at least once during the ages of 3 to 5 years.  Rule 4. (2) Hearing screening of school-aged children shall be done at least in grades K, 2, and 4, or screening shall be done biennially starting at age 5 and continuing at least to age 10.  Infants and toddlers are unfortunately not included in this law. Hearing and Vision Screening Requirements* Pre-school XX Kindergarten X 1 st Grade X 2 nd Grade X 3 rd Grade X 4 th Grade X 5 th Grade X 7 th Grade X 9 th Grade X *Some local health departments may schedule screenings at different intervals. Call your local health department for more information.

8. What is OAE screening? o An objective method that screens hearing in a range of sound frequencies critical for normal speech and language development o OAE screening can help to detect sensorineural hearing loss occurring in the cochlea o It can also call attention to issues in the outer & middle ear. (fluid, wax)

9. Most practical method because:  Does not require a behavioral response from the child  Is quick and painless  Can be conducted by anyone who is trained to use the equipment and is skilled in working with children

10. The Screening Protocol. o Perform an initial screening of both ears on every child (birth to three years of age) who has been found eligible for Part C. o Any ear not passing the initial (1st OAE) screening is screened again (2 nd OAE) within approximately 2 weeks of the first screen. o If the ear does not pass the 2nd OAE screen, the child must be evaluated by a health care provider to determine whether there is an outer or middle ear condition (blockage, fluid, structural anomaly, etc.) interfering with accurate completion of the OAE screening. Treatment or monitoring may be needed.

11. The Screening Protocol. o Once the health care provider gives medical clearance, indicating that there are no conditions present that would impede an accurate screening, an OAE rescreen is conducted again. o If the ear does not pass this OAE rescreen, the child should be referred to a pediatric audiologist for a diagnostic evaluation. This referral is usually made by a health care provider in coordination with the Early On ® program.

12. Pass When the pathway through the ear is clear (no blockage or fluid), the OAE response is a reliable indication that the inner ear (cochlea) is functioning normally

13. Refer or Fail  If the equipment does not pick up a sufficient cochlear response, the ear will not pass the screening.  If blockage or fluid in the hearing pathway impedes the sound going to the cochlea or the response coming back out, the ear will not pass the screening.  OAE screening is designed to identify children whose cochlear function may be permanently impaired, but it will also help identify children who may have a temporary hearing loss due to otitis media (middle ear infection) or excessive wax buildup in the ear canal.  When a child doesn’t pass, further professional evaluation is required to determine the source of the problem and possible treatment.

14. When to repeat screen:  Probe falls out during screening  Too much noise in area  Baby was moving, vigorously sucking, or crying  Probe appears blocked when removed from the ear

15. Do not screen repeatedly.  Remember your goal is not to pass every baby. A baby with hearing loss may falsely pass with multiple screenings. Screening repeatedly is not cost effective or an efficient use of time.

16. Caring for OAE equipment.  Cleaning the Probe. “Old” gold faced unit-Remove tubing and microphone from probe, push cleaning tool through metal tubes. “Newer” blue faced unit-Remove and replace probe nozzle if necessary: use fingernail to “unlock” clip, gently pull off. Install new nozzle onto probe body.  Storing the Equipment.  Place a clean ear tip on probe after each test and before storing equipment to help reduce dust build-up in probe.  Calibration: Performed annually by company. Is usually available at the annual Early On Conference.

17. Michigan Department of Community Health: Vision Program

18. Public Act 368 of 1978, Part 93 Hearing and Vision Rules R325.3274 – Frequency of Screening  Rule 4. (1) Hearing and vision screening of preschool children shall be done at least once during the ages of 3 to 5 years  Rule 4. (2) Vision screening of school-aged children shall be done at least in grades 1,3,5,7 and 9 or done biennially starting at age 6 for those not in a formal education program  Infants and toddlers are not included in this law Hearing and Vision Screening Requirements* Pre-school XX Kindergarten X 1 st Grade X 2 nd Grade X 3 rd Grade X 4 th Grade X 5 th Grade X 7 th Grade X 9 th Grade X *Some local health departments may schedule screenings at different intervals. Call your local health department for more information.

20. Screening with the SureSight™ o An objective method that screens vision, beginning at 6 months of age, for infants and toddlers o The SureSight™ screens for common refractive vision problems including near and farsightedness, astigmatism (asymmetrical focus), and unequal power between the eyes

22. Most practical method because:  Minimal cooperation is needed, making it effective for young children  Lights and sounds engage children’s attention  It is quick and painless  Can be conducted by anyone who is trained to use the equipment and is skilled in working with children

23. Training  MDCH consultants can provide full-day trainings on the use and care of the OAE or the SureSight opportunities for supervised practice on young children Training for those who will regularly use the equipment Minimum 6/maximum 10  Contact Tiffany Kostelec at kostelect@michigan.gov if you are interested in scheduling a trainingkostelect@michigan.gov Partnering with neighboring ISD’s helps meet the minimum number to host a training

24. Hands-On Training  Our MDCH vision and hearing consultants can provide tips during training to help ensure that the screening of infants and toddlers is valid and reliable  Practice makes perfect. Plan to use the tool regularly!  Practicing on co-workers, children, grandchildren, neighbors, and others, can help you feel more comfortable before you screen on-site with a family

25. Help!! Data and Reporting  MDCH would appreciate receiving data to: show the value of screening the 0-3 population (prevalence of identified H & V issues) Justify MDCH staff time providing free trainings throughout Michigan  Quarterly data would include: The number of children screened The number who passed the screening The number of children who failed the screening The number of children who were referred for evaluation The number of children who are receiving treatment

26. Michigan Department of Community Health: Early Hearing Detection and Intervention (EHDI)

27. What is the Early Hearing Detection and Intervention (EHDI) Program? The goal of EHDI is to maximize linguistic competence and literacy development for children who are deaf or hard of hearing. (Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs.)

28. National and state initiative promoting “1-3-6 Goals”:  All newborns will be screened for hearing loss no later than 1 month of age, preferably before hospital discharge.  Those not passing screening should have a comprehensive audiologic evaluation no later than 3 months of age.  All infants identified with hearing loss will receive appropriate early intervention services no later than 6 months of age.

29. EHDI Report Card. How are we doing? o 98% babies screened no later than 1 month of age. o 52% diagnosed no later than 3 months. o 166 babies with permanent hearing loss in 2011. o 41% Intervention no later than 6 months.

30. LOSS TO FOLLOW-UP (LTF) National LTF for 2010 = 39.4% *Number and percent of infants lost to follow-up after refer from final hearing screen: MI EHDI Data, 2007-2011. Birth Year ReferredLTF 20071925117661.1% 2008163995458.2% 2009151880052.7% 2010153183354.4% 2011155782252.8%

31. Counseling Parents  Effective communication of results to families has an influence on follow up behaviors.  Balance between reassurance and importance of follow-up with medical professional and possible follow-up testing.

32. Counseling Parents “Your child may or may not have a hearing loss…but let’s be sure about it. If further testing shows hearing loss, the earlier we get started helping the child, the better.”

33. Failed Result Script “Your baby did not pass the hearing screening test today. This does not necessarily mean that your baby has a hearing loss. It only means that he or she needs further testing. It is VERY important for you to take your baby for follow up testing to be sure about your baby’s hearing. Let’s see if we can schedule that appointment before you leave today.”

34. A Pass result Script “Your baby has passed the newborn hearing screen. However, your baby’s hearing status can change at any time, so I am providing you with a brochure that talks about how normal babies develop. If you are ever worried that your baby cannot hear, talk to your baby’s doctor right away and ask your doctor for a referral for a hearing test.”

35. What’s Next?  Undiagnosed Hearing Loss in Infants is a “Neurodevelopmental Emergency”.  Mandated Screenings Should Include 1 Year of Age & 2 Years of Age.  Local Health Departments Could be Referral Sites with Additional Staff, Equipment, and Money.

36. Why is Periodic Hearing Screening so Important?  Despite progress related to newborn hearing screening, approximately 10% of newborns in the US are not screened at birth, and 30-50% of infants who do not pass their newborn hearing screening are lost to follow-up.  Estimated incidence of sensorineural hearing loss in the US triples between birth and the school-age years, from 1 in 300 to 3 in 300.  Hearing loss can occur at any time in a child’s life. Progressive and late-onset may occur at any time throughout early childhood.  Approximately 35% of preschool children will have repeated ear infections before 3 years of age, nearly always resulting in fluctuating conductive hearing loss.  Without regular, physiologic screening, hearing loss is often impossible to detect.  Children with unidentified hearing loss are often identified with speech and language delays, described as having behavioral disorders or learning disabilities.

37. Where’s Your Audiologist? If you don’t already have a connection with a pediatric audiologist in your community, you can call Michelle Garcia at 517-335-8878 or contact her at garciam@michigan.gov to receive help in finding one!garciam@michigan.gov Is this your audiologist?

38. Reporting?  2006 Mandated reporting: Public Act 31 of 2006 (SB 794). Medical professionals must report to the state:  All hearing screenings on children less than twelve months of age; and  All diagnosed hearing loss in children under three years of age.

39. By working together we can give all babies born in Michigan a better chance at success.