1. Issues in Implementing Early Hearing Detection and Intervention Programs

2. If so, why? What issues still need to be addressed?,, Is Implementation of Universal Newborn Hearing Screening Accelerating?

3. Improved Screening Techniques/Equipment Why is Implementation of Newborn Hearing Screening Accelerating?

4. Improved Screening Techniques/Equipment Acceptance by Policy Makers Why is Implementation of Newborn Hearing Screening Accelerating?

5. 1988:Commission on Education of the Deaf 1990:Healthy People 2000 Report 1993:NIH Consensus Statement 1994:Joint Committee on Infant Hearing 1998:American Academy of Pediatrics ) ) ) ) )

6. Improved Screening Techniques/Equipment Acceptance by Policy Makers Why is Implementation of Newborn Hearing Screening Accelerating? Increased Number of Successful Programs

7. Number of Hospitals Doing Universal Newborn Hearing Screening Number of Programs

8. Improved Screening Techniques/Equipment Acceptance by Policy Makers Why is Implementation of Newborn Hearing Screening Accelerating? Increased Number of Successful Programs Public Awareness/Demand

9. Implementing Universal Newborn Hearing Screening Enlisting Support for UNHS Selecting an Appropriate Protocol Procedural Issues Communicating with Stakeholders Training Screeners Keeping Refer Rates Low Managing Data and Patient Information 1. 2. 3. 4. 5. 6. 7. Coordination and Reporting Financing the Program Care of Equipment Diagnosis and Follow-up Passing a Legislative Mandate 8. 9. 10. 11. 12.

10. Enlisting Support for UNHS Support from authoritative groups Many other hospitals are doing it successfully Has newborn hearing screening already become the standard of care? Physician support is essential It won't happen without support of the nursing staff 2 2 2 2 2

11. Selecting Equipment and Determining an Appropriate Protocol for Your Hospital Which equipment is best? 2

13. Selecting Equipment and Determining an Appropriate Protocol for Your Hospital Which equipment is best? Wouldn't it be better to wait for the next generation of screening equipment? 2 2

14. Selecting Equipment and Determining an Appropriate Protocol for Your Hospital Which equipment is best? Wouldn't it be better to wait for the next generation of screening equipment? How many tests will be included in the screening protocol? 2 2 2

15. Protocols Used in Universal Newborn Hearing Screening Programs Screening Procedures Before Hospital Discharge After Hospital Discharge Number of Programs TEOAETEOAE and ABR44 DPOAE 5 AABR 24 AABRTEOAE2 TEOAE and ABR----------5 TEOAE and AABR----------2 DPOAE and ABR----------1 TEOAE----------4 DPOAE----------3 AABR----------28 ABR----------2

16. Selecting Newborn Hearing Screening Equipment Cost of equipment Cost of supplies Initial training Time to screen 2 2 2 2 AABR or TEOAE or DPOAE

17. Selecting Newborn Hearing Screening Equipment (continued) What is being measured? 2 AABR or TEOAE or DPOAE what degree of hearing loss is detected? availability of frequency specific information which parts of auditory pathway are measured? 4 4 4

18. Selecting Newborn Hearing Screening Equipment (continued) Scoring criteria and ease of interpretation Flexibility of administration Flexibility of use Referral rates 2 2 2 2 AABR or TEOAE or DPOAE

19. Selecting Newborn Hearing Screening Equipment (continued) Screening in noisy situations False negatives Cost per infant screened 2 2 2 AABR or TEOAE or DPOAE

20. Summary: Selecting the Best Newborn Hearing Screening Equipment What do you want the equipment to do? What is the cost of purchase and use? How good is customer support?

21. Procedural Issues Who's in charge? Who will do the screening? Making sure every baby is screened Scoring Should screening be done with the parents present? 2 2 2 2 2

22. Communication: With Parents Results of the screening test When to communicate the results What the test really means? Awareness of language development milestones 2 2 2 2

23. Communication: With Physicians General awareness of the program and its importance What were the results for their patients? Helping physicians understand the importance of follow up Medical management issues 2 2 2 2

24. Communication: With the Hospital Recording results in the child's medical record Documenting the successes and difficulties of the program Regular reports to hospital administrators Justifying ongoing program support 2 2 2 2

25. Training Initial training Don't train more people than you need Regular supervision Retraining to accommodate staff turnover 2 2 2 2

26. Keeping Refer Rates Low Schedule screening when babies are in the best behavioral state Make a second effort to screen initial fails prior to discharge Minimize noise and confusion in the screening area Have backup equipment and supplies readily available You don't need informed consent For OAE procedures, probe fit is critical For Automated ABR procedures, screen when myogenic activity is low 2 2 2 2 2 2 2

27. Data and Patient Information Management Benefits of computer-based data management Should you design your own, modify an existing, or purchase a system? Safeguarding your data 2 2 2

28. Coordination and Reporting Data-based program management and refinement Make people aware of your successes Coordination with early intervention programs Coordination with other databases 2 2 2 2

29. Financing the Program How much does it really cost? Will insurance pay for newborn hearing screening? Is newborn hearing screening cost beneficial? Grants and donations 2 2 2 2

30. Care of Equipment and Supplies An ounce of prevention is worth a pound of cure Don't assume people know how to take care of computers Most hospitals provide computer support--ask for it 2 2 2

31. Diagnosis and Follow up A good screening program is not necessarily a good early identification program Referral to pediatric audiologists Age-appropriate techniques Age at diagnosis Provision of amplification Timely, appropriate, family-centered intervention is the real goal 2 2 2 2 2 2

32. Legislative Mandates Is legislation a good idea? Don't wait to start until you have a legislative mandate What's happening in other states? 2 2 2

33. Most Babies Are Already Being Screened. Do We Really Need a Legislative Mandate? The last 10% to 20% is the toughest Turnover of key staff or hospital ownership changes Reporting and Data Management Becoming a part of the Public Health System 2 2 2 2

34. Obtaining a Legislative Mandate What should the bill contain? Recruiting supporters Negotiating the legislative process When the legislation passes, the work begins 2 2 2 2

35. What Should the Bill Contain? Strong differences of opinion - - ASHA model is one opinion Pros and cons of including components in the law versus in Rules and Regulations Short-term versus long-term strategies Is a bad bill better than no bill? 2 2 2 2

36. Recruiting Support for the Bill Parents Responsible Executive Agency Physicians Audiologists Hospital Administrators Insurance Industry (public and private) Advocacy Groups Service Clubs (Quota, Lions, Sertoma, etc.) Early Intervention Agency 2 2 2 2 2 2 2 2 2

37. Negotiating the Legislative Process Three most important factors in getting a bill passed: Get the right sponsor Emotion is more effective than logic Don't fall asleep at the switch It ain't over til it's over 2 ) ) ) 2 2 2

38. When the Legislation Passes, the Work Begins Writing the Rules and Regulations Don't forget who helped you Spreading the word In God we Trust.......from all others, we require data 2 2 2 2 )

39. Legislation Is Not A Guarantee In 1990, 16 states had legislative mandates for newborn hearing screening 7 of those had no program 6 of the 9 programs were not state wide Dpmt of Educ officials in 10 of 16 states unaware legislation existed Rules and regulations are often as important as legislation Absence of appropriations limits the impact of many legislative mandates 2 ) ) ) 2 2

40. . Status of Universal Newborn Hearing Screening in the United States. Percentage of Births Screened 90%+ 21 - 50% 1 - 20% 3 51 - 90%