1

Connecting UNHS and Part C

2

Children with identified hearing loss are connected with appropriate early intervention services

Children without a documented follow-up from NHS have an opportunity for follow-up

Concerns

• Children not passing UNHS who need follow-up

• Children with late-onset or progressive losses that can’t be identified by UNHS programs

• Children not screened at birth

3

ECHO Teams established in 19 StatesECHO Teams established in 19 States

100+ EHS/MHS grantees trained and implementing OAE screening100+ EHS/MHS grantees trained and implementing OAE screening

Outcome data collected / 10,000+ children to dateOutcome data collected / 10,000+ children to date

OregonWashingtonUtahNorth CarolinaDCNebraskaKansasColoradoIowaPennsylvania

AlaskaMichiganArkansasConnecticutIllinoisHawai’iMissouriKentuckyVirginia

Head Start Head Start EEarly arly CChildhood hildhood HHearing earing OOutreach utreach ((ECHOECHO) Initiative) Initiative

Otoacoustic Emissions Otoacoustic Emissions Hearing (OAE) ScreeningHearing (OAE) Screening

An objective, highly reliable method

Currently considered the most appropriate method for screening 0-3 yr olds (and all others for whom behavioral methods are not adequate)

Otoacoustic Emissions Otoacoustic Emissions (OAE) Screening(OAE) Screening

PainlessRequires no behavioral responseIs quick and efficient to administerCan be performed by anyone with skills in working with children and trained in procedureCan be performed in play environments or while a child is sleepingCan help identify potential presence of ear infections as well as permanent hearing losses

Screen in playful settings

Screen during nap time

Identifying a wide range of hearing Identifying a wide range of hearing health needs includinghealth needs including……

Permanent Hearing Loss Ear infections/Otitis mediaFluidExcessive ear wax

OutcomesOutcomes

n=6038 children screened

505 (8%) were referred for medical/audiological follow-up

239 exited program before diagnosis was completed

43 Passes OAE screening before referral was completed

220 Diagnosed and treated

OutcomesOutcomesOf the 220 referred for medical/audiologic follow-up:

2 sensorineural loss

1 mixed loss

3 permanent conductive

19 fluctuating conductive loss

98 otitis media (requiring medication, tubes or surgery)

3 eustacian tube disorder

18 treated for excessive earwax

70 normal/no treatment

Identification RateIdentification Rate

Approx. 1 1000

Loss to follow-up of approximately 40% in some cases (children exited program)

Identification RateIdentification Rate

Approx. 1 per 1000

Loss to follow-up of approximately 40% in some cases (children exited program)

A number of children already enrolled in Part C services without hearing loss identified

What methods do Part C (and 619 Preschool) programs use to screen hearing

How satisfied are programs with current methods

What is their knowledge of the use of objective screening methods (OAE)

Hearing Screening/Assessment In Part C and 619 Programs

IDEA of 2004: PL 108-446

Relevant to:

• Child Find

• Evaluation• Assessments

Part C Regulations (existing reg’s)

Section 303.322(3) Evaluation (for eligibility determination) and Assessment (for determining individual strengths, needs and services) must include the following:

i. a review of pertinent records related to child’s current health status and medical history

ii. an evaluation of the child’s current level of functioning in each of the following developmental areas:

a) Cognitive b) Physical, including vision and hearingc) Communication d) Social or emotional developmente) Adaptive

Survey of Part C and Part B Local Programs

Purpose:

Explore hearing assessment methods ChallengesSatisfaction with methodsInterest in OAE Information

Methods: Email request sent via State Part C and 619 Coordinators

Part C Programs: 155 responses from 17 states: Strongest representation from TX, MA, KS, CT, HI

Part B Programs: 175 responses from 11 states: Strongest representation from TN, VA, MN, NC, MI, VT

Question 1: As part of the initial evaluation process, estimate the percentage of children whose hearing status is typically assessed using each of these methods. (Part C Program Results)

The percent of programs who reported using the following methods with at least 60% of children:

Question 1: As part of the initial evaluation process, estimate the percentage of children whose hearing status is typically assessed using each of these methods. (Part B Program Results)

The percent of programs who reported using the following methods with at least 60% of children:

Question 2: Does a PASSING result from the newborn hearing screening satisfy your hearing assessment requirement for children over 1 year?

Implications

• Frequently-used methods (i.e., response to sounds/noisemakers, family questionnaires), are not most accurate

• Newborn hearing screening results often used beyond reasonable time period

• Pure tone audiometry is a challenge with developmentally delayed children

• Audiologist assessments, used by a small number of programs, require access to pediatric audiologists and are expensive.

Question 3: As a part of ongoing, periodic evaluation of children already enrolled in your program, estimate the percentage of children who receive an annual assessment by an audiologist or OAE screening:

Part C Programs

Question 3: As a part of ongoing, periodic evaluation of children already enrolled in your program, estimate the percentage of children who receive an annual assessment by an audiologist, OAE screening, or pure-tone audiometry:

Part B Programs

Implications Pertaining to the Assessment of Hearing for Children After Enrollment?

• Audiologist assessments or OAE’s are not used routinely with children on an ongoing basis

• Potential for hearing loss to go undetected

Question 4: How satisfied are you with your current methods of obtaining hearing assessment information?

Question 5: How knowledgeable are you about Otoacoustic Emissions (OAE) screening?

Question 8. How interested are you in receiving more information about how Otoacoustic Emissions (OAE) screening could be used by program staff to screen young children for hearing loss?

What were the challenges faced in obtaining hearing assessment information frequently reported by Part

C and Part B providers? (open-ended responses)

• Difficulty assessing children with cognitive delays who cannot respond to pure tones, have poor attention spans, sensitivity to being touched

• Poor parent follow through and transportation issues

• Pediatricians not recommending further assessment

• Obtaining existing hearing assessment information from other agencies/providers in a timely manner

• School environment not conducive for testing (noise, space, interruptions)

• Insufficient supply of audiologists, equipment

What does this tell us about provider knowledge, interest, and need re: OAE screening?

The minority of Part C and Part B providers are knowledgeable

The majority of Part C and Part B providers are interested in learning more

Use of OAE screening can address their issues:

Doesn’t require audiologists, speech/language therapists

Works with all children, regardless of functioning level

Can be performed in any setting: classroom, home

Reduces problems with parent transportation and need to schedule separate appointment

What does our experience in

Head Start teach us

about how we must move

forward with improving

practices in Part C?

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Key Elements In Implementing Key Elements In Implementing an OAE Screening Programan OAE Screening Program

Audiologist partnerAppropriate equipment ProtocolTrainingMonitoring for quality implementation Technical assistance Tracking, follow-up and identification of conditions

ResourcesResources

Instructional Guide and Training Video

Screening Protocol and Forms

Data tracking system and monthly technical assistance data reports

ECHO Team Training and Technical Assistance Manual

Hands on Train-the-Trainer Training

Hands on Training for EHS/MHS staff

Audiologist’s Training Manual: How to help Head Start Programs Improve Hearing Screening Practices

Checklist for Implementing OAE Screening in Head Start Settings

Website resources www.infanthearing.org/earlychildhood

ResourcesResources

www.infanthearing.org/earlychildhood eclkc.ohs.acf.hhs.govhttp://ehsnrc.org/

Most 0-3 year olds are still not receiving hearing screenings using up-to-date methods.

The grass actually IS greener on the other side of this fence….

www.infanthearing.org/earlychildhood