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Pennsylvania Department of Health Out-of-Hospital Pennsylvania Department of Health Out-of-Hospital Birth Newborn Hearing Birth Newborn Hearing Screening Initiative Initiative
National EHDI Conference
Washington, D.C.
February 2 -3, 2006
Arthur A. Florio, DOH EHDI Program AdministratorPatti Matlock, R.N., DOH Nursing Services ConsultantLynn Shay, R.N., BSHS, CPM
Presenter Disclosure Information
In the past 12 months, we have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussedin our presentation. This presentation will not include discussion of pharmaceuticals or devices that have not been approved by the FDA or will be discussing unapproved or “off-label” uses of pharmaceuticals or devices.
Pennsylvania FactsPennsylvania Facts
Population 12,406,292Population 12,406,292 44,817 square miles44,817 square miles 67 Counties and 2,567 67 Counties and 2,567
municipalitiesmunicipalities 48 of 67 counties are rural48 of 67 counties are rural 1/3 of the population lives1/3 of the population lives
in a rural areain a rural area
1999 – began demonstration program in 26 birthing hospitals
IHEARR Act passed in November of 2001
Statewide program implemented July 1, 2002
Universal EHDI in all 125 birthing hospitals
~ 142,000 hospital births per year
Approx. 3,400 out-of-hospital births per year
Pennsylvania’s Early Hearing Pennsylvania’s Early Hearing Detection & Intervention ProgramDetection & Intervention Program
2004 Hospital Hearing Screenings2004 Hospital Hearing Screenings
141,465 138,750 137,734
1,470
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000 Total Births
Newborns Screened
Initially
Newborns Completing
Screening
Newborn Not Passing
Screening
Why undertake a special Why undertake a special effort to screen Out-of-effort to screen Out-of-Hospital Births?Hospital Births?
IHEARR Act specifically mentions the need to screen out-of-hospital births within 30 days.
HRSA UNHSI grant has a requirement to assure broadest possible representation of culturally distinct groups in programs sponsored by MCHB.
Pennsylvania has historically concentrated cultural communities where out-of-hospital birthing is preferred. These communities have continued to grow.
Out-of-Hospital (OOH) BirthsOut-of-Hospital (OOH) Births
Pennsylvania had a total of 3,390 Pennsylvania had a total of 3,390 out-of-hospital births in 2003.out-of-hospital births in 2003.
1,066 OOH births (32%) occurred 1,066 OOH births (32%) occurred at Freestanding Birthing Centers at Freestanding Birthing Centers (FBCs); 120 FBC births were to (FBCs); 120 FBC births were to out-of-state residents. out-of-state residents.
2,324 OOH births (68%) occurred 2,324 OOH births (68%) occurred in residences, midwives’ homes in residences, midwives’ homes or other locations (the majority or other locations (the majority were home births).were home births).
Geographic ConcentrationsGeographic Concentrations
5 of the 15 FBCs accounted for 5 of the 15 FBCs accounted for 64% of the 1066 births that 64% of the 1066 births that took place in FBCs during took place in FBCs during 2003.2003.
5 counties accounted for 62% 5 counties accounted for 62% of all OOH births in the of all OOH births in the residence, physician’s office & residence, physician’s office & other location category (i.e., other location category (i.e., places other than FBCs).places other than FBCs).
2003 OOH Births – Top 20 2003 OOH Births – Top 20 Counties of Occurrence (all Counties of Occurrence (all types included)types included)
1,000 +
Erie
Crawford43
Warren112
McKeanPotter
Tioga Bradford Susquehanna
Wayne
LackawannaWyoming
Luzerne
SullivanLycoming
Columbia
Pike
Monroe
CarbonNorthum
berlandSchuylkill
Dauphin
Delaware78
Lancaster 1047
Berks 215
Lehigh
Bucks
Philadelphia 88
Lebanon 38
Montour
Northampton
Montgomer
y 187
Chester 124
York 38
Snyder
Adams
Perry
Cumberland 86
Union 211
Franklin 99
Centre33
Blair
BedfordSomerse
t
Cambria
Indiana 120
Westmoreland
Clinton
CameronElk
Forest
Venango
Butler Armstrong
Jefferson
Mercer97
Lawrence
Beaver
Allegheny 135
Washington
Greene
Mifflin 104
Fulton
Huntingdon
Clearfield
Clarion
Fayette
100 - 200
50 – 100
40 - 80
Juniata -- 162
2003 OOH Births – Areas of Concentration2003 OOH Births – Areas of Concentration
RedRed – – Areas with concentrated home births (townships/boroughs with at least 5 and as Areas with concentrated home births (townships/boroughs with at least 5 and as many as 104 home births – residence of mother)many as 104 home births – residence of mother)
Colored Dots with surrounding shadingColored Dots with surrounding shading – – Locations of FBCs and the twps./boroughs Locations of FBCs and the twps./boroughs where mothers who gave birth in those FBCs reside. where mothers who gave birth in those FBCs reside.
MIDWIVES DOING OOH BIRTHSMIDWIVES DOING OOH BIRTHS
Certified Nurse Midwife (CNM)Certified Nurse Midwife (CNM)
Certified Professional Midwife (CPM) Certified Professional Midwife (CPM)
Direct Entry Midwife (DEM)Direct Entry Midwife (DEM)
Traditional MidwifeTraditional Midwife
Some RNs and midwife apprentices also Some RNs and midwife apprentices also do newborn hearing screening for OOH do newborn hearing screening for OOH births.births.
Overcoming Barriers in Getting OOH Overcoming Barriers in Getting OOH Birth Hearing Screening Started . . .Birth Hearing Screening Started . . .
Lack of interest among midwivesLack of interest among midwives Midwives not convinced of its importance Midwives not convinced of its importance
– viewed hearing screening as an – viewed hearing screening as an additional unnecessary procedureadditional unnecessary procedure
Patients not interestedPatients not interested Hospitals hesitant to allow hands-on Hospitals hesitant to allow hands-on
in-service training for midwives doing in-service training for midwives doing OOH birthsOOH births
Getting StartedGetting Started . . .. . .
Contact midwives in the counties with the Contact midwives in the counties with the largest concentrations of OOH birthslargest concentrations of OOH births
Contact DOH district office community Contact DOH district office community health nurseshealth nurses
Finding midwives interested in Finding midwives interested in performing newborn hearing screening performing newborn hearing screening
FBCs are a good venue for hands-on FBCs are a good venue for hands-on trainingtraining
Establishing OOH Birth Establishing OOH Birth Screening Networks . . .Screening Networks . . .
Traveling Midwife Traveling Midwife Networks Networks
Freestanding Freestanding Birthing FacilitiesBirthing Facilities
How Machines are PurchasedHow Machines are Purchased
Advisory Committee helped Advisory Committee helped formulate equipment specificationsformulate equipment specifications
Bid Procurement -- bid Bid Procurement -- bid specification is issued and vendors specification is issued and vendors submit bidssubmit bids
The lowest bid that meets all The lowest bid that meets all requirements of the bid requirements of the bid specification gets the salespecification gets the sale
Bid Specification Highlights . . . Bid Specification Highlights . . .
Must be Portable Must be Portable Auditory Brainstem Response (ABR)Auditory Brainstem Response (ABR) Battery-powered (5-hour operating Battery-powered (5-hour operating
capability on charge)capability on charge) Pass/Not-pass result indication Pass/Not-pass result indication Consumables for 500 screenings/unit Consumables for 500 screenings/unit 3-year service agreement & warranty3-year service agreement & warranty Vendor TrainingVendor Training
Communication is ImportantCommunication is Important
Mailing reports Mailing reports and informationand information
Faxes and e-mailFaxes and e-mail
Telephones and Telephones and cell phones cell phones
CURRENT PLACEMENT OF PORTABLE ABR CURRENT PLACEMENT OF PORTABLE ABR SCREENING UNITSSCREENING UNITS
Pennsylvania’s EHDI program has purchased 15 portable ABR unitsPennsylvania’s EHDI program has purchased 15 portable ABR units The units are currently deployed at the above locationsThe units are currently deployed at the above locations Upcoming prospective placement at Pittsburgh FBCUpcoming prospective placement at Pittsburgh FBC Another bid purchase is in process for 5 additional units Another bid purchase is in process for 5 additional units
Preparing for Hearing ScreeningPreparing for Hearing Screening
Quiet environmentQuiet environment Make sure infant is Make sure infant is
tired and fedtired and fed Identify and prepare Identify and prepare
sensor sites sensor sites Connect SensorsConnect Sensors Fit ear-tip on the probeFit ear-tip on the probe Prepare the machinePrepare the machine View results and View results and
record resultsrecord results
Maintaining the NetworksMaintaining the Networks
15 portable ABR screening units in use15 portable ABR screening units in use 6 traveling midwives share 3 machines6 traveling midwives share 3 machines 12 units are at FBCs12 units are at FBCs Maintaining equipment Maintaining equipment
- 5 machines need yearly replacement cables- 5 machines need yearly replacement cables
- knowledge of warranties - knowledge of warranties Budgeting for and ordering supplies Budgeting for and ordering supplies
ReportsReports
L-X
XX
XX
XX
Pennsylvania Department of HealthDivision of Newborn Disease Prevention and IdentificationPO Box #90, Harrisburg PA, 17108-0090
Phone: (717) 783-8143 TTY: (717) 783-6514
Out of Hospital BirthsThis form is for out of hospital births and includes Hearing Screening
BABY’S LAST NAME FIRST
S &
S
90
3L
OT
# W
-01
1 (
Rev. 1
2/0
2)
12
34
56
7DRAW DATE TIME AMPM
CHECK HERE IF BABY IFBABY IS LESSTHAN 24 HRS. OLD
MOTHER’S LAST NAME FIRST
ADDRESS
CITY, STATE, ZIP
PHONE (MOTHER)
MOTHER’S SOCIAL SECURITY NUMBER
HEARING SCREENING: (OUT OF HOSPITAL BIRTHS ONLY)
NAME OF SCREENER: ______________________DATE: __________
R. Ear Pass ____ Refer ____ Not Screened ____ Refused ____L. Ear Pass ____ Refer ____ Passed but High Risk Factor ____
LOCATION OF BIRTH:HOME BIRTHING CENTER
OTHER
____________________________
DRAWN BY
SEXM
F
BIRTHDATE BIRTHTIMEAM
PM
BABY’S MED. REC. NO. BABY’S RACE
WHITE ASIAN
BLACK AM. IND.
PAC. IS. OTHERGESTATION
(WEEKS)
BIRTHWEIGHT
(GRAMS)
BIRTHSINGLE OTHER ____
A B CTRANSFUSED?
SM. VOL
EXCHANGEDATE __________
SPECIMEN
INITIAL
REPEAT
PREV. CARD #
MATERNAL HEPATITIS B STATUS
Hbs Ag POS. NEG. ?FORM SUBMITTED BY
PHONE NUMBER ADDRESS IF OTHER THAN BIRTH FACILITY
MIDWIFE
BABY’S PHYSICIANLAST FIRSTNAME NAME
MOTHER’S MEDICAL ASSISTANCE #
HISPANIC ?
YES NO
1234567SubmitterKeep Top Copy
OOH Birth Filter Paper
Success of ProgramSuccess of Program
Diagnosed 2 newborn infants with Diagnosed 2 newborn infants with hearing losshearing loss
Both infants have amplification Both infants have amplification Awareness among the Lancaster County Awareness among the Lancaster County
about hearing screening and the outcomeabout hearing screening and the outcome More interest among the midwives in More interest among the midwives in
screeningscreening
ChallengesChallenges
Fluctuating birthing volumes Fluctuating birthing volumes
Generating interest among clienteleGenerating interest among clientele
Equipment recallsEquipment recalls
Cooperation among midwives sharing Cooperation among midwives sharing screening unitsscreening units
Submission of data and referralsSubmission of data and referrals
Goals for 2006Goals for 2006
Purchase 5 ABR hearing machinesPurchase 5 ABR hearing machines
Screen 50-60% of OOH birthsScreen 50-60% of OOH births
Provide educational updates for Provide educational updates for midwivesmidwives
Initiate feedback newsletter for midwifesInitiate feedback newsletter for midwifes
Serving special sub-groups of the Serving special sub-groups of the population in Pennsylvaniapopulation in Pennsylvania
The Plain PeopleThe Plain People Agrarian Agrarian
communitiescommunities Rural residentsRural residents Complementary Complementary
healthcare seekershealthcare seekers
Barriers to screening in subgroupsBarriers to screening in subgroups
The Old Order Amish and The Old Order Amish and MennonitesMennonites
Cost of test and subsequent treatmentCost of test and subsequent treatment
Transportation and accessTransportation and access
The Old Order Amish and The Old Order Amish and MennonitesMennonites
Educational levelEducational level Reliance on non-allopathic healthcareReliance on non-allopathic healthcare Community belief systemsCommunity belief systems
Routine preventive care devaluedRoutine preventive care devaluedTechnologyTechnologyAvoid being uniqueAvoid being uniqueAdvice from grandparentsAdvice from grandparentsGovernment aidGovernment aid
Other Plain Groups, Farmers, Rural Other Plain Groups, Farmers, Rural Dwellers and Complementary Dwellers and Complementary
healthcare groupshealthcare groups
CostCost TransportationTransportation Ease of accessibilityEase of accessibility Distrust of government programsDistrust of government programs Distrust of allopathic healthcare/technologyDistrust of allopathic healthcare/technology
Removing the BarriersRemoving the Barriers Personal relationship with the providerPersonal relationship with the provider Patient educationPatient education Free testingFree testing Portable processPortable process Incorporation into routine careIncorporation into routine care Viewing hearing screening as a standard of careViewing hearing screening as a standard of care Relating early treatment to adult productivityRelating early treatment to adult productivity
Cultural Competence:Cultural Competence: The chameleon effectThe chameleon effect
Home visits
“Hitching posts”
Personal relationship
The teachable moment
Informing multiple generations
Net results for outreach screening Net results for outreach screening services:services:
Decreasing disparity in healthcare services Decreasing disparity in healthcare services to population sub-groups (Healthy People to population sub-groups (Healthy People 2010 goal)2010 goal)
Increased screening to children at riskIncreased screening to children at risk Increased awareness of importance of Increased awareness of importance of
prevention, screening and early intervention prevention, screening and early intervention among often marginalized groupsamong often marginalized groups
Screening and Intervention Screening and Intervention LinkedLinked
Screening followed by Screening followed by intervention in all subgroupsintervention in all subgroups
Intervention amenableIntervention amenable
Summary and Lessons LearnedSummary and Lessons Learned
Research is KeyResearch is Key Identify and Overcome BarriersIdentify and Overcome Barriers Recognize Cultural DiversitiesRecognize Cultural Diversities Program Requires Investment of Staff Program Requires Investment of Staff
Time and EffortTime and Effort Develop Relationships Based on TrustDevelop Relationships Based on Trust CommunicationsCommunications