1. Early Childhood Hearing Screening:
NOTES-
During this presentation, I’m going to be talking about a project entitled the Hearing Head Start Project we are currently conducting in which we are significantly updating hearing screening practices for children 0-3 served by migrant, american indian and early head start programs.
Describe how the success of newborn hearing screening led to the current project to assist in updating hearing screening practices for children birth to three served by Migrant, American Indian and Early Head Start.
I will then introduce you to the hearing screening approach being used in the current project, the process we have undertaken to prepare and support participating grantees in these efforts and will review our findings, including our most recent steps to establish state-based systems that can sustain and replicate the activities of the pilot project
The Next Step For EHDI’s?

2. The National Center for Hearing Assessment & Management (NCHAM) at Utah State University
NCHAM serves as the Maternal and Child Health Bureau’s National Technical Assistance system to help hospitals, states, and professionals implement and improve comprehensive and effective Early Hearing Detection and Intervention (EHDI) programs.
Working together, we have achieved significant advances in our ability to screen newborns for hearing loss.

3. Advances in Technology
Technological advances in the past 10 years have made it possible to conduct highly reliable physiological hearing screening of children as young as a few hours old. Hearing screening equipment has become:
More affordable
More portable
Easier to use

4. Otoacoustic Emissions (OAE) Screening
OAE Hearing Screening is ideal for screening young children because it:
Is painless for the child
Requires no behavioral response
Is quick and efficient to administer
Can be performed by anyone skilled in working with children and trained to do the procedure
Can help identify the potential presence of ear infections as well as permanent hearing losses

5. Otoacoustic Emissions (OAE) Screening
Demonstration of the OAE Screening process

6. Why is Continuous Hearing Screening so Important?
As many as 50% of infants who refer from newborn hearing screening are lost to follow-up.
Hearing loss can occur at any time in a child’s life.
Approximately 35% of preschool children will have repeated ear infections before 3 years of age, sometimes resulting in fluctuating conductive hearing loss.
Without regular, physiologic screening, hearing loss is often impossible to detect.

9. Status of Head Start Hearing Screening Practices
Head Start’s “Performance Standards” reflect a long-standing commitment to hearing screening: All children are to receive a hearing screen within 45 days of enrollment; however:
Most Grantees are relying on subjective, outdated screening methods such as hand clapping, bell ringing, and parent questionnaires to screen children 0 – 3 years of age.
Most Grantees are unaware that Otoacoustic Emissions (OAE) technology, used widely in newborn hearing screening programs, can also be used successfully in early childhood settings.

12. Status of Head Start Hearing Screening Practices
Head Start’s “Performance Standards” reflect a long-standing commitment to hearing screening: All children are to receive a hearing screen within 45 days of enrollment; however:
Most Grantees are relying on subjective, outdated screening methods such as hand clapping, bell ringing, and parent questionnaires to screen children 0 – 3 years of age and/or physician physical exam.
Most Grantees are unaware that Otoacoustic Emissions (OAE) technology, used widely in newborn hearing screening programs, can also be used successfully in early childhood settings.

13. The Hearing Head Start Project
From 2001 – 2004, NCHAM has been conducting a pilot project helping Grantees. . .
Migrant Head Start
American Indian Head Start
Early Head Start
. . . update hearing screening practices for children years of age using OAE technology.

14. Hearing Head Start Project Participants in UT, WA, and OR :
Receive training and OAE equipment
Conduct OAE screening on all children years of age following a prescribed protocol
Document screening and follow-up outcomes; submit data on a regular basis
Receive ongoing technical assistance and linkage with additional hearing resources

15. The Hearing Head Start Project --Outcomes to Date:
104 Migrant, American Indian, and Early Head Start staff trained
Representing 19 grantees (69 program sites) in WA, OR, and UT
Using 36 pieces of OAE equipment
Almost 3000 children screened

16. OAE Screening/Referral Outcomes
2953 children screened (using a 3 - step screening protocol)
183 (6%) were referred for medical/audiological follow-up
(60 currently “in process” to receive initial follow-up)
60 identified with a hearing loss or disorder
11 being monitored/diagnosis unknown
12 normal/no treatment required
27 lost to follow-up or parent refused follow-up

17. OAE Screening/Referral Outcomes
Of the 60 identified with a hearing loss or disorder:
1 severe, bilateral, sensorineural loss
2 mild-moderate, bilateral, permanent conductive losses
8 bilateral, fluctuating conductive losses requiring treatment
41 otitis media (ear infection) requiring treatment
1 treated for occluded Pressure Equalization tubes
1 treated for perforated eardrum
6 treated for excessive ear wax

18. Qualitative Results
Grantees report that they prefer OAE screening over previous methods because it:
Is quick (averages 5 minutes per child), reliable, and incurs no additional personnel costs; can be done by CNAs, health coordinators, disability specialists, nursing professionals, home visitors, family advocates and other early childhood staff
Builds confidence that their hearing screening approach is based on sound audiological practices
Expedites referral for follow-up; contributes significantly to the child’s Medical Home because OAE screening is not currently available in most health care provider offices/clinics
Contributes to community hearing health as information is shared with Part C providers, Community Health Clinics and health care providers.

24. No, equipment is not enough.
Is purchasing OAE Equipment all that is needed for Head Start Grantees to successfully update their hearing screening practices?
No, equipment is not enough.
It is vital that Grantees be provided with:
Audiological supervision
Training
An appropriate screening & follow-up protocol
Ongoing technical assistance & linkage to local/state hearing resources

25. Without training, audiological supervision and an appropriate screening protocol, Grantees are likely to experience problems related to:
Inappropriate selection of/care of screening equipment
High refer rates –
over-referral to physicians/audiologists
OAE technology misconstrued as a diagnostic tool
Confusion over the screener’s role/limitations
Under-identification of hearing loss and other disorders
Inappropriate follow-up diagnostic and intervention services

26. Essential Elements of the Training Process
Supervised by a pediatric audiologist assisted by other experienced screeners; incorporates large group instruction, small group coaching (1:5) and individual assistance
Hosted at Grantee site where participants experience supervised “hands-on” screening practice (and Grantee children are screened as an extra benefit!)
Structured around audio-visual and written materials that standardize the training, are responsive to multiple learning styles (participants receive their own copy of the materials for refresher/retraining purposes)
Requires approximately 6 hours to complete

27. Essential Elements of the Screening Protocol
Reduces over-referral to physicians/audiologists, while promoting timely referral as needed
Screens for hearing health concerns in the outer, middle and inner ear

28. Essential Elements of the Screening Protocol
Screening and Follow-up Forms (provided to screeners to document screening results) reflect the screening protocol
Screeners are visually prompted on the correct “next step” in the protocol

30. Ongoing Technical Assistance Topics
Acceptable refer rates; how to improve screening; strategies for screening in homes
Acceptable modifications to the protocol (sometimes needed in remote/rural areas)
Equipment care and concerns
Establishing relationships with local audiologists and medical providers
Clarifying the Medical Home concept
Responding to primary care provider questions & concerns about the OAE screening
Reviewing individual cases of children requiring rescreening or follow-up
Understanding follow-up medical/audiological recommendations

33. Sustainability & Replicability
Early Childhood Hearing Outreach
During 2003 – 2004, NCHAM’s Hearing Head Start Team has begun working with existing state-based Early Hearing Detection and Intervention (EHDI) programs and other stakeholders to:
Establish ECHO Teams that will “echo” the training and technical assistance activities of the original Hearing Head Start Pilot Project

34. Sustainability & Replicability
State-based ECHO teams will:
Sustain and expand early childhood OAE hearing screening activities in Oregon, Utah and Washington, providing ongoing technical assistance to Grantees
Initiate early childhood OAE hearing screening activities in Kansas and North Carolina

35. Sustainability & Replicability
To enable ECHO teams, the NCHAM Hearing Head Start Team created and refined a comprehensive training package

36. Sustainability & Replicability
The comprehensive training package includes:
Hearing Screening & Follow-up Diagnostic Forms
Getting a Hearing Head Start: Updating Early Childhood Hearing Screening --Program Screening Guide (for Grantees)
Getting a Hearing Head Start: Updating Early Childhood Hearing Screening Practices -- Training Video (four-part training video reproduced in CD-ROM and VHS formats)
The (((ECHO))) Team Training and Technical Assistance Manual -- outlining 14 implementation steps for establishing ECHO Teams, collaborating with state hearing-health stakeholders, and providing training & ongoing technical assistance to Grantees.

37. ECHO Team Preparation
NCHAM Hearing Head Start Team provided a 2-day training workshop to ECHO Teams to:
Familiarize ECHO Teams with concepts, materials and resources
Model the training process
Assist ECHO Teams in developing implementation plans

38. ECHO Team Activities
Provide ongoing technical assistance to Grantees engaged in OAE screenings
Provide initial training to at least 5 new Grantees
Provide basic information to all Head Start Grantees in the state serving children years of age
Assist in data collection of screening results
Develop plan for sustainability
Establish linkages between newborn hearing screening and early childhood hearing screening activities in the state

39. Parents say it the best…

40. Who can help put the pieces together so that ALL young children can . . . .
. . . receive the benefit of high-quality, early and continuous hearing screening???

41. Part C Providers, Community Health Clinics, Indian Health Services
WE CAN!
Head Start Regional Offices
Head Start State Collaboration Offices
Head Start Technical Assistance Providers
Migrant, American Indian and Early Head Start Grantees
State Early Hearing, Detection and Intervention (EHDI) Programs
Part C Providers, Community Health Clinics, Indian Health Services
Parents and Professional Organizations
a 501c(3) non-profit organization working on behalf of all children and families