Universal Newborn Hearing Screening
and Intervention Evaluation
Shanna Shulman, PhD
Melanie Besculides, DrPH
Acknowledgments

Mathematica team:
Anna Katz
Charlotte Hanson
Henry Ireys
Keith Rathbun
Lisa Trebino
Eileen Curley

Irene Forsman, Federal Project Officer

Karl White, National Center for Hearing
Assessment and Management

Program staff
Presentation Road Map







Background
Methods
Overview of findings
Barriers and strategies
Program implementation themes
Future directions
Conclusion
Conceptual Framework for the Program
Newborn
Screening
Further
Evaluation
Intervention
Intervention
Goal
Screening
before
hospital
discharge
or within
one month
Audiologic diagnosis
by three months
Early intervention
by six months
Speech,
language,
social skills
development
on par with
peers at
school
entry
S
Birth
Family-to-family support
Newborn
Medical home
S
Program Evaluation Background

90% of infants screened for hearing loss

30-50% receive follow-up screening

MPR Evaluation:
– Program’s progress in achieving goals
– Barriers and strategies for improvement
Evaluation Focus

Diagnosis

Early intervention

Medical home

Family-to-family support
Evaluation Methods

Literature review

Survey of state and territorial program coordinators

Site visits to 8 state programs (AZ, CA, MA, MN, NE,
PA, TN, WY):
–
–
–
–
UNHSI staff
Hospital staff
AAP Chapter Champion
Audiologists
Findings


Screening is almost universal
Gaps in follow-up remain:
– Diagnostic evaluation by 3 months
– Link to early intervention
– Link to medical home
– Link to family-to-family support
Barriers to follow-up

Service system capacity

Provider knowledge

Family challenges in obtaining services

Information gaps
System Capacity: What Is Lacking

Equipment to perform screenings

Audiologists to perform evaluation

Intervention services focused on
infant/toddler hearing

Family-to-family support services
Strategies for Lack of Equipment

Seek grants to purchase equipment

Maintain alternate screening opportunities
Rate of Audiologists per 10,000 Births
WA
MT
ME
ND
VT
MN
OR
NH
ID
WI
SD
NY
WY
RI
CT
MI
PA
IA
NE
NV
OH
IL
UT
MD
IN
CO
WV
KS
CA
MO
MA
VA
NJ
DE
DC
KY
NC
TN
AZ
OK
NM
AR
SC
MS
AL
GA
TX
LA
FL
AK
Fewer than 2 audiologists per 10,000 births
2 – 2.99 audiologists per 10,000 births
3 – 3.99 audiologists per 10,000 births
HI
More than 4 audiologists per 10,000 births
Strategies for Lack of Audiology Services

Conduct outreach and training

Work to increase reimbursement
(commercial and public)
Strategies for Lack of EI, Family-to-Family
Services

Implement training, specialized curricula

Tap community resources

Partner with other organizations

Hire regional parent coordinators
Provider Knowledge: Barriers

Lack of protocols for standardized screening
and presentation of results

Low volume of patients decreases quality of
screening, follow-up, and evaluation services

Lack of provider knowledge about UNHSI and
key partners

“Wait-and-see” attitude among PCPs
Strategies for Lack of Protocols and
Low Patient Volume

Provide TA to screening hospitals

Make follow-up appointment before
discharge

Concentrate screening in small group

Provide ongoing training, particularly for lowvolume areas
Strategies for Lack of Knowledge, Attitudes

Outreach and training

Single point of contact to link families to
services

Education, colleague-to-colleague training
Family Barriers to Obtaining Services

Pre-authorization requirements, lack of insurance

Need to go to unfamiliar location for evaluation

Lack of transportation to audiologist

Transient living situations and language barriers
Strategies to Help Families Get Services

Facilitate pre-authorization or enrollment in
public assistance programs

Establish relationship with audiology center
Strategies to Help Families Get Services

Partner with existing programs

Develop education materials in other
languages

Use translation services

Hire bilingual staff
Information Gaps: Barriers

Poor communication among hospitals, PCPs,
audiologists, and program

Data systems not accessible to providers

Privacy laws impede agency sharing
Strategies to Improve Communication

Train hospital staff on importance of relaying
complete information

Use existing data sources to complete
missing data fields

Use specialized software, metabolic
screening cards, or electronic birth
certificates to convey results
Strategies to Improve Use of Data

Use web-based systems to facilitate real-time
transmission of results, contact information,
and track follow-up

Establish data-sharing procedures

Secure family permission for data sharing
1. Program Implementation Varies by State

Legislation

Infrastructure

Privacy laws
2. More Mature Programs Are Farther Along

Established reporting relationships

Internal data and tracking capabilities

Relationships with early intervention and
family-to- family support services

Effective follow-up strategies

Cross-agency communication
3. Program Priorities on the Right Track

Improving data and tracking systems

Enhancing provider knowledge

Increasing EI service system capacity

Improving family services
4. Infant Hearing Loss Is Low Incidence

Volume matters

Providers require ongoing training

Coordinating entity is important
Future Program Directions

Improve data systems to support
surveillance and follow-up

Build additional capacity

Develop family-to-family support services

Promote importance of early detection
As Things Stand

Programs poised to take action

Model of collaboration in public health
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