Primary Goal

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Primary Goal

• I - Identification/Screening 1 month
• D - Diagnosis/Evaluation 3 months
• E - Early Intervention 6 months
• A - Additional Assessment(s)
• L - Linking to (2 days)
• A - Appropriate
• S - Services
• A And 45 days
• P Programs

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Percent of Neonates Screened - 1998
gt90
75-89
60-74
40-59
25-39
10-24
5-9
lt 5
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Early Hearing Detection and Intervention
Progression of States towards Universal Newborn
Hearing
Screening
50
lt5
6-9
10-24
15-39
40-59
60-74
75-89
gt90
40
30
Number of States
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10
0
1993
1995
1996
1997
1998
1999
2000
Year
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Pediatric Evaluations

• Use a combination of behavioral and objective
  tests to obtain frequency-specific, ear-specific,
  and family/child-specific information
• Ensure that referral sources have audiologists
  and associated professionals with appropriate
  knowledge and skills to perform pediatric
  evaluations and that the facility has the
  necessary instrumentation for the audiologists to
  obtain the necessary information

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Basic Pediatric Auditory Evaluation

• Case History and Parental Report
• Related Screenings / Referral Information
• Age-appropriate Behavioral Assessment Protocols
• Objective Assessment Protocols
• Integration and Interpretation of Results
• Counseling with Family and Professionals
• Recommendations
• Referrals

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Ensuring Appropriate and Timely Diagnosis of
Hearing Loss

• Develop collaborative efforts of hospitals and
  community referral sources
• Monitor data management, tracking and follow-up
  procedures
• Collect accurate contact information with a
  back-up (family member, friend, email address,
  cell phone number, etc.)
• Establish a brief time-frame between screening
  and follow-up measures

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Timely Diagnosis (cont.)

• Clearly communicate follow-up procedures and
  schedule appointments with families if possible,
  before they leave the facility
• Enlist support from medical community
  (pediatricians, medical home, etc.)
• Ensure proper training for all personnel in the
  EHDI program
• Address cultural and diversity issues as
  applicable for each phase of the EHDI program

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Benchmarks (JCIH, 2000)

• Newborns screened by 1 month
• Infants with hearing loss identified by 3 months
• Infants enrolled in family-centered EI by 6
  months
• Professionals are knowledgeable
• Amplification use begins within 1 month of
  diagnosis
• Ongoing audiological management - not to exceed 3
  month intervals

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Timeframe for Communication

• PL 105-17 IDEA
• Referral for evaluation must be made to a public
  agency within 2 working days of identification
• IFSP must be developed by a multidisciplinary
  team within 45 days of receiving the referral
• State and local policies and procedures

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Using the Team Approach

• Developing and identifying professional
  interactions to ensure that families receive
  sensitive, timely, seamless service between
  screening, evaluation and early intervention
  services.
• Communication ACCESS is viewed as the key element
  for developing successful communication skills.

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What do Parents Want?

• Early identification of hearing loss
• Timely receipt of test results
• Professional service and interactions
• Information (verbal and written)
• Emotional support

Summary - Uzcategui Yoshinaga-Itano SKIHI
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Parents Advice for Professionals

• Listen to us!
• Be knowledgeable
• Be honest
• Be professional
• Tell us everything

Mertens, D. M., Sass-Lehrer, M., Scott-Olson,
K. (2000) Sensitivity in the
family-professional relationship Developmental
implications for young deaf and
hard of hearing children. In P. Spencer, C.
Erting, M. Marschark (Eds.). The
deaf child in the family and at school.
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Parents Views of Professionals

• Professionals have information that parents do
  not have
• Professionals may have biases
• Professionals wait until parents are ready
• Professionals wait until parents ask
• Professionals are uncomfortable sharing bad
  news
• Professionals may underestimate parents

Mertens, D. M., Sass-Lehrer, M. Scott-Olsen, K.
(2000)
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Communication w/ Stakeholders

• Who?
• Families, medical home, involved professionals,
  state systems
• What?
• Information! available/not available,
  recommendations, referrals, requests
• When?
• As its available, follow-up letters as
  appropriate, w/in outlined timelines
• How?
• Person to person, written, as requested

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Use Acronyms with Care

• Auditory Brainstem Response
• ABR
• BAER
• BSER
• BSERA
• EAP
• BEAP
• BERA
• AABR
• SABR
• ABAER

• Otoacoustic Emissions
• OAE
• EOAE
• SFOAE
• TEOAE
• DPOAE
• COAE
• TOAE
• DPE
• ADP

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Acronyms (cont.)

• AAA
• AAP
• ASHA
• CDC
• HRSA
• JCIH
• MCHB
• MDNC
• NCCC
• NCHAM
• OSERS
• RIHAP

• EHDI
• UNHS
• IFSP
• WBN
• NICU
• IDEA
• JCAHO
• PCP
• HMO
• DRG
• CPT

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Emerging Trends

• Minority populations are increasing
• By the year 2020, it is estimated that the
  minority populations will exceed the white
  population in the US
• The diversity of professionals serving those with
  hearing loss is limited

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General Population vs Audiologists