Vision, Dental, and Hearing Screening Registry Development in BC

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Vision, Dental, and Hearing Screening Registry
Development in BC

• Brenda Poon
• December 6, 2007
• Assistant Professor
• Early Childhood Screening Research and Evaluation
  Unit
• Human Early Learning Partnership (HELP),
• College for Interdisciplinary Studies, UBC
• e-mail brenda.poon_at_ubc.ca

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Early Childhood Screening in BC

• In March, 2005, the provincial government in BC
  announced funding for universal hearing, dental,
  and vision screening for every child under age 6.
  
• Rationale that early and timely treatment could
  provide the healthiest outcomes.
• Sound Start BC Early Hearing Program.
• Early Childhood Vision Screening Program.
• Early Childhood Dental program.

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Early Hearing Detection and Intervention

• Designed to identify infants who may have
  permanent, childhood hearing loss as well as
  those infants who require further audiological
  assessment to confirm hearing status.
• All newborns screened for hearing loss before 1
  month of age.
• Diagnostic audiologic evaluation before 3 months
  of age.
• Intervention by 6 months of age (Joint Committee
  on Infant Hearing, 2000).

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Early Childhood Vision Screening - Objectives

• To separate those students who probably have no
  vision problems from those who should be examined
  by an eye doctor for assessment and possible
  treatment.
• To prevent and identify early those target
  conditions a) amblyopia, b) significant
  refractive errors, and c) strabismus that are
  treatable and that have been associated with
  partial sight or blindness when left untreated.
• Activities Early Childhood Vision Screening and
  Case-Finding
• Pilot public health vision screening for 3
  year olds.
• Vision screening of children in kindergarten.

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Early Childhood Dental Services

• Aim for multiple, integrated strategies for
  prevention of both early childhood caries and
  periodontal diseases.
• To reduce the incidence of early childhood caries
  in infants, toddlers, preschoolers, and
  kindergarten students.
• To identify early childhood dental concerns and
  facilitate childs/parents/families access to
  dental health services or treatment.

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Early Identification, Prevention, and Intervention

• Hearing Late versus early detection
• Average age of diagnosis of hearing loss with
  traditional model is typically over 3 years old.
• Late diagnosis of hearing loss is associated with
  delays in childrens speech, language and
  social-emotional development.
• Dental Cumulative effects
• Early recognition of those who are at risk for
  dental diseases is essential as dental diseases
  are usually progressive and cumulative.
• Caries is an infectious and transmissible disease
  that young children often acquire through a
  primary caregiver before age 3.

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• Vision Risk of loss of vision function
• Amblyopia is the most common cause of vision
  disturbance in childhood.
• Left untreated, risk of vision loss in the
  non-amblyopic eye. Vision impairment can range
  from socially significant visual loss to
  blindness (Rahi, Logan, Timms, Russell-Eggitt,
  Taylor, 2002).

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Role of HELPs Early Childhood Screening Unit

• 1) Database development.
• 2) Program evaluation.
• 3) Research.
• Aim to provide support for
• Consistency in data collection, recording, and
  reporting.
• Program management and quality data and
  information.
• Program planning and development.

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Database DevelopmentA central resource that can
support...
Registry
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Application of a Participatory Model

• Involvement of representatives from each Health
  Authority and the Ministry of Health discuss
  program goals, performance areas, core outcome
  indicators, and fit with objectives.
• Obtaining input about currently used methods for
  evaluating services identifying gaps and needs.
• Develop a framework for program monitoring,
  evaluation, and reporting.

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Develop a central resource by investigating
Program Theory or Logic
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Project 1 Vision Screening Evaluation Questions

• What is the uptake of screening following
  invitation?
• Is screening identifying children with the target
  conditions (amblyopia, strabismus, refractive
  errors)?
• Which neighbourhoods/areas are associated with
  the highest and lowest rates of referral and
  follow-through to diagnostic services? Are there
  differences in the rates of diagnosed vision
  conditions across different areas?
• To what extent is screening associated with more
  young children seeing an eye doctor?

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Vision Screening Data Collection Child
Screening Referral and Follow-Up Data
Data Collection 2007-08, 2008-09, 2009-10,
2010-11
Cross-sectional, annual data collection
Year 1 (2007-08) Pilot programs that will
eventually be phased into a universal preschool
screening program
Core Data Set N 4800 to 6000 (screening
referrals)
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Vision Screening Data Elements

• Individual-level child demographics
• Child First Name
• Child Last Name
• Child PHN
• Child Gender
• Child Date of Birth
• Child City
• Child Postal Code
• Screening Information
• Screening Location Data
• Screening Date
• VA/refraction R and L (Pass/Fail for each of
  Sphere, Cylinder, Difference)
• Stereopsis (Pass/Fail)

• Follow-up Actions
• Follow-up Data (parent reported)
• Outcome at 1st, 2nd, 3rd contact (awaiting
  resolution, no apparent problem, under
  treatment/care, unwilling to follow
  recommendation)
• Eye Examination Results/Treatment Approach
• Eye examination date
• Visual acuity (Right/Left)
• Visual acuity (Right/Left)
• MSP Data
• Eye examination date
• Eye doctor location
• Diagnostic code and billing code

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Project 2 Dental Evaluation Questions

• Effectiveness of Preventive Services
• What is the most effective combination of
  strategies being provided in the health
  authorities to prevent early childhood dental
  disease?
• Is there an improvement in oral health? By
  community? By vulnerability?
• Are health promotion interventions for changing
  family dental health practices making an impact
  toward reducing early childhood caries?

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Dental Data Elements

• Kindergarten survey outcomes
• HAs collect by child
• Child First Name
• Child Last Name
• Child PHN
• Child Gender
• Child Date of Birth
• Child Postal Code
• Child Dental Survey Code
• School Name
• School Address
• School Postal Code

• Electronic health record containing preventive
  dental service data
• Service Date
• Client Session Type code
• Referral Source
• Dental type
• Dental Status
• Dental Action
• Dental Outcome
• Family risk behaviours
• Fluoride varnish applications
• Sealant applications

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Project 3 Phase 1 Prospective DataBC Early
Hearing Surveillance Tool

• Beginning in October, 2007, web-based data system
  is being phased into screening and diagnostic
  sites across the province.
• The program involves a multidisciplinary group of
  health care and early intervention professionals
  across the province
• This electronic data system will be a central
  data repository for initiating and developing a
  longitudinal record of a deaf and hard of hearing
  childs health and development.

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Supports Coordination of a Continuum of Services

• Infant screening for congenital, childhood
  hearing loss.
• Ongoing surveillance for later onset and
  progressive hearing loss.
• Medical and audiological assessment for
  confirmation of hearing status.
• Amplification for optimal use of available
  hearing.
• Educational programming to promote communication,
  language, and social-emotional development.

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The registry attempts to address issues of

• fragmented systems of data collection.
• several independent, stand-alone systems.
• inconsistencies in data collected.
• disjointed records for each child.
• potential for duplication in records.
• inability to fully support a universal newborn
  hearing screening program.

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Phase 2 Retrospective Data

• Data would be collected from records of
• Children who were born between October 1, 1997 to
  September 30, 2007 and identified with permanent,
  childhood hearing loss.
• Children whose hearing losses were not identified
  through population-based newborn hearing
  screening.

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Investigating the effectiveness of the newly
developed provincial, newborn hearing screening
and early intervention program

• Age of identification
• Age of amplification fitting
• Age of enrollment into intervention

• Degree, type, and laterality of hearing loss

• Age of identification
• Age of amplification fitting
• Age of enrollment into intervention

• Degree, type, and laterality of hearing loss

EDI
FSA
EDI
1997
Historical Data Data Abstraction
2007
BC Early Hearing Surveillance Tool
(Unscreened)
(Screened)
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Insert data flow
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Supplementing the database

• Access to Services
• To what extent do screening activities reach
  vulnerable populations? How can the program
  identify and reach members of the populations
  most in need of access to these services (e.g.,
  people who do not normally access public health)?
• What factors influence access and utilization of
  services?
• Payment at time of appointment (Azogui-Levy et
  al., 2003). Patients reluctant to pay at the
  point of access with reimbursement to follow
  later and dentists were hesitant to treat without
  immediate payment of the fee rather than later
  reimbursement by the insurance plan
• lt40 of children who failed screening exams
  received the suggested follow-up vision exams
  from eye care professionals (Kimel, 2006).
• Awareness of support programs Some parents were
  unaware that funding programs for vision care
  that were available,
• Perceived quality of the programs Others
  perceived funded exams and glasses to be of
  inferior quality.
• Scheduling difficulties when the child was a
  member of a large household or did not have a
  consistent home. Appointment times restricted to
  parents work hours also acted as barriers to
  referral follow-up.

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J Can Dent Assoc. 2006 May72(4)319. Oral health
care in Canada--a view from the trenches.
(Ontario)
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Variation by geography and community

• Evidence of geographic differences in prevalence
  of early childhood caries. (e.g., urban-rural).
  (Hansen et al., 2006).
• Evidence of higher prevalence rates and levels of
  severity in five-year-old children in First
  Nations Communities (Peressini et al., 2004).
  Provincial average for hospitalization rates for
  dental procedures for all children aged 0 to 14
  is 6.7 per 1000. For Aboriginal children alone,
  it is 10 times greater (68 per 1000) (BC
  Provincial Health Officer, 1997).
• At age 5, children of lower socio-economic status
  had a higher incidence and severity of caries
  (Thomson et al., 2004).
• Environmental factors that influence dental
  caries levels include access to fluoridated
  water, toothpaste, good diet, and preventive
  dentistry. Social inequities of these
  environmental factors contribute to the poorer
  oral health of children living in
  socio-economically disadvantaged communities. One
  of the results is a social gradient in caries
  prevalence (Thomson et al., 2004).

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Assessing Screening Impact Drawing from
Multiple Layers
What are possible socio-demographic, community,
or program factors that may be impacting
childrens outcomes?
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HELPs Vision

• To create, promote and apply new knowledge
  through leading interdisciplinary research to
  help children thrive.
• Thank you!
• HELPs website
• www.earlylearning.ubc.ca
• ECD Mapping Portal
• http//ecdportal.help.ubc.ca

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Proportion of Students Vulnerable Physical
Health and Well-Being scale of the EDI Based on
Provincial cutoffs, 2004
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1999-2000 Kindergarten vision tests, proportion
of referrals