Can You Hear Me Now?

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Can You Hear Me Now?

• What is the best way to identify potential
  Hearing Vision issues? MDCH can help.
• Early On Webinar - June 20, 2013
• Tiffany Kostelec, MDCH Consultant for Early On
• Jennifer Dakers, MDCH Hearing Consultant
• Dr. Rachel Schumann, MDCH Vision Consultant
• Dr. Michelle Garcia, MDCH EHDI Loss to
  Follow-up Consultant

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Why are we here?

• MDE purchased OAE and Sure Sight screening
  equipment in 2003
• Intent provide objective screening that results
  in valid reliable hearing and vision status.
• Prevent late identified hearing vision
  problems. Subjective screening (paper pencil
  questionnaire) only i.d. 50 of those with
  problems.
• Update new staff/Refresh previously trained
  staff.
• Trends in Use/Non-Use
• Repair Issues
• Troubleshooting Issues
• Calibration Issues
• Training Issues

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Overview of Webinar.

• MDCH Hearing and Vision screening Program
• Equipment.
• Is screening important?
• Available trainings.
• Lets work together.
• MDCH EHDI Program.
• What is EHDI?
• EHDI National and State goals
• EHDI stats.
• How can you help?

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What Is A Screening?

• Screening is the first step in identifying
  infants and toddlers that may have a hearing or
  vision loss

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• Michigan Department of Community Health Hearing
  Program

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Public Act 368 of 1978, Part 93 Hearing
and Vision RulesR325.3274 Frequency of
Screening

• Rule 4. (1) Hearing and vision screening of
  preschool children shall be done at least once
  during the ages of 3 to 5 years.
• Rule 4. (2) Hearing screening of school-aged
  children shall be done at least in grades K, 2,
  and 4, or screening shall be done biennially
  starting at age 5 and continuing at least to age
  10.
• Infants and toddlers are unfortunately not
  included in this law.

Hearing and Vision Screening Requirements
Pre-school X X
Kindergarten X  
1st Grade   X
2nd Grade X  
3rd Grade   X
4th Grade X  
5th Grade   X
7th Grade   X
9th Grade   X
Some local health departments may schedule screenings at different intervals. Call your local health department for more information. Some local health departments may schedule screenings at different intervals. Call your local health department for more information. Some local health departments may schedule screenings at different intervals. Call your local health department for more information.
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What is OAE screening?

• An objective method that screens hearing in a
  range of sound frequencies critical for normal
  speech and language development
• OAE screening can help to detect sensorineural
  hearing loss occurring in the cochlea
• It can also call attention to issues in the outer
  middle ear. (fluid, wax)

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Most practical method because

• Does not require a behavioral response from the
  child
• Is quick and painless
• Can be conducted by anyone who is trained to use
  the equipment and is skilled in working with
  children

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The Screening Protocol.

• Perform an initial screening of both ears on
  every child (birth to three years of age) who has
  been found eligible for Part C.
• Any ear not passing the initial (1st OAE)
  screening is screened again (2nd OAE) within
  approximately 2 weeks of the first screen.
• If the ear does not pass the 2nd OAE screen, the
  child must be evaluated by a health care provider
  to determine whether there is an outer or middle
  ear condition (blockage, fluid, structural
  anomaly, etc.) interfering with accurate
  completion of the OAE screening. Treatment or
  monitoring may be needed.

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The Screening Protocol.

• Once the health care provider gives medical
  clearance, indicating that there are no
  conditions present that would impede an accurate
  screening, an OAE rescreen is conducted again.
• If the ear does not pass this OAE rescreen, the
  child should be referred to a pediatric
  audiologist for a diagnostic evaluation. This
  referral is usually made by a health care
  provider in coordination with the Early On
  program.

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Pass

• When the pathway through the ear is clear (no
  blockage or fluid), the OAE response is a
  reliable indication that the inner ear (cochlea)
  is functioning normally

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Refer or Fail

• If the equipment does not pick up a sufficient
  cochlear response, the ear will not pass the
  screening.
• If blockage or fluid in the hearing pathway
  impedes the sound going to the cochlea or the
  response coming back out, the ear will not pass
  the screening.
• OAE screening is designed to identify children
  whose cochlear function may be permanently
  impaired, but it will also help identify children
  who may have a temporary hearing loss due to
  otitis media (middle ear infection) or excessive
  wax buildup in the ear canal.
• When a child doesnt pass, further professional
  evaluation is required to determine the source of
  the problem and possible treatment.

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When to repeat screen

• Probe falls out during screening
• Too much noise in area
• Baby was moving, vigorously sucking, or crying
• Probe appears blocked when removed from the ear

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Do not screen repeatedly.

• Remember your goal is not to pass every baby. A
  baby with hearing loss may falsely pass with
  multiple screenings. Screening repeatedly is not
  cost effective or an efficient use of time.

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Caring for OAE equipment.

• Cleaning the Probe.
• Old gold faced unit-Remove tubing and
  microphone from probe, push cleaning tool through
  metal tubes.
• Newer blue faced unit-Remove and replace probe
  nozzle if necessary use fingernail to unlock
  clip, gently pull off. Install new nozzle onto
  probe body.
• Storing the Equipment.
• Place a clean ear tip on probe after each test
  and before storing equipment to help reduce dust
  build-up in probe.
• Calibration Performed annually by company. Is
  usually available at the annual Early On
  Conference.

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• Michigan Department of Community Health Vision
  Program

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Public Act 368 of 1978, Part 93 Hearing
and Vision RulesR325.3274 Frequency of
Screening

• Rule 4. (1) Hearing and vision screening of
  preschool children shall be done at least once
  during the ages of 3 to 5 years
• Rule 4. (2) Vision screening of school-aged
  children shall be done at least in grades 1,3,5,7
  and 9 or done biennially starting at age 6 for
  those not in a formal education program
• Infants and toddlers are not included in this law
  

Hearing and Vision Screening Requirements
Pre-school X X
Kindergarten X  
1st Grade   X
2nd Grade X  
3rd Grade   X
4th Grade X  
5th Grade   X
7th Grade   X
9th Grade   X
Some local health departments may schedule screenings at different intervals. Call your local health department for more information. Some local health departments may schedule screenings at different intervals. Call your local health department for more information. Some local health departments may schedule screenings at different intervals. Call your local health department for more information.
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Screening with the SureSight

• An objective method that screens vision,
  beginning at 6 months of age, for infants and
  toddlers
• The SureSight screens for common refractive
  vision problems including near and
  farsightedness, astigmatism (asymmetrical focus),
  and unequal power between the eyes

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Most practical method because

• Minimal cooperation is needed, making it
  effective for young children
• Lights and sounds engage childrens attention
• It is quick and painless
• Can be conducted by anyone who is trained to use
  the equipment and is skilled in working with
  children

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Training

• MDCH consultants can provide
• full-day trainings on the use and care of the OAE
  or the SureSight
• opportunities for supervised practice on young
  children
• Training for those who will regularly use the
  equipment
• Minimum 6/maximum 10
• Contact Tiffany Kostelec at kostelect_at_michigan.gov
  if you are interested in scheduling a training
• Partnering with neighboring ISDs helps meet the
  minimum number to host a training

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Hands-On Training

• Our MDCH vision and hearing consultants can
  provide tips during training to help ensure that
  the screening of infants and toddlers is valid
  and reliable
• Practice makes perfect. Plan to use the tool
  regularly!
• Practicing on co-workers, children,
  grandchildren, neighbors, and others, can help
  you feel more comfortable before you screen
  on-site with a family

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Help!! Data and Reporting

• MDCH would appreciate receiving data to
• show the value of screening the 0-3 population
  (prevalence of identified H V issues)
• Justify MDCH staff time providing free trainings
  throughout Michigan
• Quarterly data would include
• The number of children screened
• The number who passed the screening
• The number of children who failed the screening
• The number of children who were referred for
  evaluation
• The number of children who are receiving
  treatment

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• Michigan Department of Community Health Early
  Hearing Detection and Intervention (EHDI)

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What is the Early Hearing Detection and
Intervention (EHDI) Program?

• The goal of EHDI is to maximize linguistic
  competence and literacy development for children
  who are deaf or hard of hearing.
• (Year 2007 Position Statement Principles and
  Guidelines for Early Hearing Detection and
  Intervention Programs.)

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National and state initiative promoting1-3-6
Goals

• All newborns will be screened for hearing loss
• no later than 1 month of age, preferably
  before hospital discharge.
• Those not passing screening should have a
  comprehensive audiologic evaluation no later than
  
• 3 months of age.
• All infants identified with hearing loss will
  receive appropriate early intervention services
  no later than
• 6 months of age.

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EHDI Report Card. How are we doing?

• 98 babies screened no later than 1 month of age.
• 52 diagnosed no later than 3 months.
• 166 babies with permanent hearing loss in 2011.
• 41 Intervention no later than 6 months.

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LOSS TO FOLLOW-UP (LTF)National LTF for 2010
39.4
Birth Year Referred LTF LTF
2007 1925 1176 61.1
2008 1639 954 58.2
2009 1518 800 52.7
2010 1531 833 54.4
2011 1557 822 52.8
Number and percent of infants lost to follow-up
after refer from final hearing screen MI EHDI
Data, 2007-2011.
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Counseling Parents

• Effective communication of results to families
  has an influence on follow up behaviors.
• Balance between reassurance and importance of
  follow-up with medical professional and possible
  follow-up testing.

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Counseling Parents

• Your child may or may not have a hearing
  lossbut lets be sure about it. If further
  testing shows hearing loss, the earlier we get
  started helping the child, the better.

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Failed Result Script

• Your baby did not pass the hearing screening
  test today. This does not necessarily mean that
  your baby has a hearing loss. It only means that
  he or she needs further testing. It is VERY
  important for you to take your baby for follow up
  testing to be sure about your babys hearing.
  Lets see if we can schedule that appointment
  before you leave today.

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A Pass result Script

• Your baby has passed the newborn hearing screen.
  However, your babys hearing status can change
  at any time, so I am providing you with a
  brochure that talks about how normal babies
  develop. If you are ever worried that your baby
  cannot hear, talk to your babys doctor right
  away and ask your doctor for a referral for a
  hearing test.

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Whats Next?

• Undiagnosed Hearing Loss in Infants is a
  Neurodevelopmental Emergency.
• Mandated Screenings Should Include 1 Year of Age
  2 Years of Age.
• Local Health Departments Could be Referral Sites
  with Additional Staff, Equipment, and Money.

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Why is Periodic Hearing
Screening so Important?

• Despite progress related to newborn hearing
  screening,
  approximately 10 of newborns in the US are
  not screened at birth, and 30-50 of infants who
  do not pass their newborn hearing screening are
  lost to follow-up.
• Estimated incidence of sensorineural hearing loss
  in the US triples between birth and the
  school-age years, from 1 in 300 to 3 in 300.
• Hearing loss can occur at any time in a childs
  life. Progressive and late-onset may occur at any
  time throughout early childhood.
• Approximately 35 of preschool children will have
  repeated ear infections before 3 years of age,
  nearly always resulting in fluctuating conductive
  hearing loss.
• Without regular, physiologic screening, hearing
  loss is often impossible to detect.
• Children with unidentified hearing loss are often
  identified with speech and language delays,
  described as having behavioral disorders or
  learning disabilities.

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Wheres Your Audiologist?
Is this your audiologist?
If you dont already have a connection with a
pediatric audiologist in your community, you can
call Michelle Garcia at 517-335-8878 or contact
her at garciam_at_michigan.gov to receive help in
finding one!
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Reporting?

• 2006
• Mandated reporting Public Act 31 of 2006 (SB
  794).
• Medical professionals must report to the
  state
• All hearing screenings on children less than
  twelve months of age and
• All diagnosed hearing loss in children under
  three years of age.

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By working together we can give all babies born
in Michigan a better chance at success.