Finalizing Your Overheads

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					Universal Newborn Hearing Screening
     and Intervention Evaluation

        Shanna Shulman, PhD
       Melanie Besculides, DrPH

   Mathematica team:
     Anna Katz        Charlotte Hanson
     Henry Ireys      Keith Rathbun
     Lisa Trebino     Eileen Curley
   Irene Forsman, Federal Project Officer
   Karl White, National Center for Hearing
    Assessment and Management
   Program staff
    Presentation Road Map

   Background
   Methods
   Overview of findings
   Barriers and strategies
   Program implementation themes
   Future directions
   Conclusion
        Conceptual Framework for the Program

          Newborn           Further                    Intervention       Intervention
          Screening        Evaluation                                         Goal
          Screening    Audiologic diagnosis          Early intervention      Speech,
            before       by three months              by six months           S
Birth      hospital                                                        social skills
          discharge                                                       development
           or within                                                       on par with
          one month                                                          peers at
                                Family-to-family support                      entry


                         Medical home
Program 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
     Evaluation Focus

   Diagnosis

   Early intervention

   Medical home

   Family-to-family support
             Evaluation 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

   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-up

   Service system capacity

   Provider knowledge

   Family challenges in obtaining services

   Information gaps
System Capacity: What Is Lacking

     Equipment to perform screenings

     Audiologists to perform evaluation

     Intervention services focused on
      infant/toddler hearing

     Family-to-family support services
     Strategies for Lack of Equipment

   Seek grants to purchase equipment

   Maintain alternate screening opportunities
Rate of Audiologists per 10,000 Births

                                     MT                                                                                                      ME
      OR                                                      MN
                      ID                                                      WI                                             NY
                                          WY                                                 MI                                               RI
                                                                   IA                                                   PA             NJ
            NV                                      NE
                                                                                                       OH                   MD    DE
                                                                                   IL   IN
                                               CO                                                            WV
                                                                                                                       VA         DC
 CA                                                      KS         MO                            KY

                                                                        AR                                        SC

                                                                                   MS   AL              GA


                                                                                                                                             Fewer than 2 audiologists per 10,000 births
                                                                                                                                             2 – 2.99 audiologists per 10,000 births
                                                                                                                                             3 – 3.99 audiologists per 10,000 births
                                                                                                                                            More than 4 audiologists per 10,000 births
Strategies for Lack of Audiology Services

        Conduct outreach and training

        Work to increase reimbursement
         (commercial and public)
Strategies for Lack of EI, Family-to-Family

     Implement training, specialized curricula

     Tap community resources

     Partner with other organizations

     Hire regional parent coordinators
      Provider 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
Strategies for Lack of Protocols and
        Low Patient Volume

   Provide TA to screening hospitals

   Make follow-up appointment before

   Concentrate screening in small group

   Provide ongoing training, particularly for low-
    volume areas
Strategies for Lack of Knowledge, Attitudes

     Outreach and training

     Single point of contact to link families to

     Education, colleague-to-colleague training
Family 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
Strategies to Help Families Get Services

   Facilitate pre-authorization or enrollment in
    public assistance programs

   Establish relationship with audiology center
Strategies to Help Families Get Services

      Partner with existing programs

      Develop education materials in other

      Use translation services

      Hire bilingual staff
        Information Gaps: Barriers

   Poor communication among hospitals, PCPs,
    audiologists, and program

   Data systems not accessible to providers

   Privacy laws impede agency sharing
    Strategies 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
    Strategies 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
1. Program Implementation Varies by State

                Legislation

                Infrastructure

                Privacy laws
2. 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
3. Program Priorities on the Right Track

   Improving data and tracking systems

   Enhancing provider knowledge

   Increasing EI service system capacity

   Improving family services
4. Infant Hearing Loss Is Low Incidence

     Volume matters

     Providers require ongoing training

     Coordinating entity is important
     Future 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
            As Things Stand

   Programs poised to take action

   Model of collaboration in public health

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