Universal Newborn Hearing Screening and Intervention Evaluation Shanna Shulman, PhD Melanie...
-
Upload
jack-johnston -
Category
Documents
-
view
217 -
download
0
Transcript of Universal Newborn Hearing Screening and Intervention Evaluation Shanna Shulman, PhD Melanie...
Universal Newborn Hearing Screening and Intervention Evaluation
Universal Newborn Hearing Screening and Intervention Evaluation
Shanna Shulman, PhDMelanie Besculides, DrPH
Shanna Shulman, PhDMelanie Besculides, DrPH
AcknowledgmentsAcknowledgments
Mathematica team:Anna Katz Charlotte HansonHenry Ireys Keith RathbunLisa Trebino Eileen Curley
Irene Forsman, Federal Project Officer
Karl White, National Center for Hearing Assessment and Management
Program staff
Mathematica team:Anna Katz Charlotte HansonHenry Ireys Keith RathbunLisa Trebino Eileen Curley
Irene Forsman, Federal Project Officer
Karl White, National Center for Hearing Assessment and Management
Program staff
Presentation Road MapPresentation Road Map
Background Methods Overview of findings Barriers and strategies Program implementation themes Future directions Conclusion
Background Methods Overview of findings Barriers and strategies Program implementation themes Future directions Conclusion
Conceptual Framework for the ProgramConceptual Framework for the Program
Newborn
Further Evaluation
Intervention
Newborn
Screening
Audiologic diagnosis by three months
Medical home
Family-to-family support
S
Birth
Early interventionby six months
Speech,language,
social skillsdevelopmenton par with
peers at schoolentry
Intervention Goal
SScreening beforehospital
dischargeor within
one month
Program Evaluation BackgroundProgram 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
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 FocusEvaluation Focus
Diagnosis
Early intervention
Medical home
Family-to-family support
Diagnosis
Early intervention
Medical home
Family-to-family support
Evaluation MethodsEvaluation 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
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
FindingsFindings
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
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-upBarriers to follow-up
Service system capacity
Provider knowledge
Family challenges in obtaining services
Information gaps
Service system capacity
Provider knowledge
Family challenges in obtaining services
Information gaps
System Capacity: What Is LackingSystem Capacity: What Is Lacking
Equipment to perform screenings
Audiologists to perform evaluation
Intervention services focused on infant/toddler hearing
Family-to-family support services
Equipment to perform screenings
Audiologists to perform evaluation
Intervention services focused on infant/toddler hearing
Family-to-family support services
Strategies for Lack of EquipmentStrategies for Lack of Equipment
Seek grants to purchase equipment
Maintain alternate screening opportunities
Seek grants to purchase equipment
Maintain alternate screening opportunities
Rate of Audiologists per 10,000 BirthsRate of Audiologists per 10,000 Births
MT
WY
ID
WA
OR
NV
UT
CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN
WI
IL IN
KY
TN
MS AL GA
FL
SC
NC
VAWV
OH
MI
NY
PA
DE
NJ
CTRI
MA
ME
VT
NH
AK
HI
Fewer than 2 audiologists per 10,000 births
2 – 2.99 audiologists per 10,000 births
More than 4 audiologists per 10,000 births
3 – 3.99 audiologists per 10,000 births
DC
MD
Strategies for Lack of Audiology ServicesStrategies for Lack of Audiology Services
Conduct outreach and training
Work to increase reimbursement (commercial and public)
Conduct outreach and training
Work to increase reimbursement (commercial and public)
Strategies for Lack of EI, Family-to-Family Services
Strategies for Lack of EI, Family-to-Family Services
Implement training, specialized curricula
Tap community resources
Partner with other organizations
Hire regional parent coordinators
Implement training, specialized curricula
Tap community resources
Partner with other organizations
Hire regional parent coordinators
Provider Knowledge: BarriersProvider 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
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
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 low-volume areas
Provide TA to screening hospitals
Make follow-up appointment before discharge
Concentrate screening in small group
Provide ongoing training, particularly for low-volume areas
Strategies for Lack of Knowledge, AttitudesStrategies for Lack of Knowledge, Attitudes
Outreach and training
Single point of contact to link families to services
Education, colleague-to-colleague training
Outreach and training
Single point of contact to link families to services
Education, colleague-to-colleague training
Family Barriers to Obtaining ServicesFamily 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
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 ServicesStrategies to Help Families Get Services
Facilitate pre-authorization or enrollment in public assistance programs
Establish relationship with audiology center
Facilitate pre-authorization or enrollment in public assistance programs
Establish relationship with audiology center
Strategies to Help Families Get ServicesStrategies to Help Families Get Services
Partner with existing programs
Develop education materials in other languages
Use translation services
Hire bilingual staff
Partner with existing programs
Develop education materials in other languages
Use translation services
Hire bilingual staff
Information Gaps: BarriersInformation Gaps: Barriers
Poor communication among hospitals, PCPs, audiologists, and program
Data systems not accessible to providers
Privacy laws impede agency sharing
Poor communication among hospitals, PCPs, audiologists, and program
Data systems not accessible to providers
Privacy laws impede agency sharing
Strategies to Improve CommunicationStrategies 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
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 DataStrategies 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
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 State1. Program Implementation Varies by State
Legislation
Infrastructure
Privacy laws
Legislation
Infrastructure
Privacy laws
2. More Mature Programs Are Farther Along2. 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
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 Track3. Program Priorities on the Right Track
Improving data and tracking systems
Enhancing provider knowledge
Increasing EI service system capacity
Improving family services
Improving data and tracking systems
Enhancing provider knowledge
Increasing EI service system capacity
Improving family services
4. Infant Hearing Loss Is Low Incidence4. Infant Hearing Loss Is Low Incidence
Volume matters
Providers require ongoing training
Coordinating entity is important
Volume matters
Providers require ongoing training
Coordinating entity is important
Future Program DirectionsFuture 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
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 StandAs Things Stand
Programs poised to take action
Model of collaboration in public health
Programs poised to take action
Model of collaboration in public health