Transcript to the PowerPoint. - CCRESA Early On Training & TA

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
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



Overview of Webinar.


MDCH Hearing and Vision screening Program
 Equipment.
 Is screening important?
 Available trainings.
 Let’s work together.
MDCH EHDI Program.
 What is EHDI?
 EHDI National and State goals
 EHDI stats.
 How can you help?
What Is A Screening?
Screening is the first step in identifying
infants and toddlers that may have a
hearing or vision loss
Michigan Department
of Community Health:
Hearing Program
Public Act 368 of 1978, Part 93
Hearing and Vision Rules
R325.3274 – 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
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
7th Grade
9th Grade
X
X
X
X
X
X
X
X
X
X
*Some local health departments may schedule screenings at
different intervals. Call your local health department for
more information.
What is OAE screening?
o An objective method that screens hearing in a range of
sound frequencies critical for normal speech and
language development
o OAE screening can help to detect sensorineural hearing
loss occurring in the cochlea
o It can also call attention to issues in the outer & middle
ear. (fluid, wax)
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
The Screening Protocol.
o Perform an initial screening of both ears on every child
(birth to three years of age) who has been found eligible
for Part C.
o Any ear not passing the initial (1st OAE) screening is
screened again (2nd OAE) within approximately 2 weeks of
the first screen.
o 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.
The Screening Protocol.
o
o
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.
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
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 doesn’t pass, further professional evaluation
is required to determine the source of the problem and
possible treatment.
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
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.
Caring for OAE equipment.

Cleaning the Probe.



“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.


“Old” gold faced unit-Remove tubing and microphone from
probe, push cleaning tool through metal tubes.
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.
Michigan Department
of Community Health:
Vision Program
Public Act 368 of 1978, Part 93
Hearing and Vision Rules
R325.3274 – 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
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
7th Grade
9th Grade
X
X
X
X
X
X
X
X
X
X
*Some local health departments may schedule screenings at
different intervals. Call your local health department for
more information.
Screening with the SureSight™
o An objective method that screens vision, beginning at 6
months of age, for infants and toddlers
o The SureSight™ screens for common refractive vision
problems including near and farsightedness, astigmatism
(asymmetrical focus), and unequal power between the
eyes
Most practical method because:

Minimal cooperation is needed, making it effective
for young children

Lights and sounds engage children’s 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
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 [email protected] if you
are interested in scheduling a training

Partnering with neighboring ISD’s helps meet the minimum number to
host a training
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
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
The
The
The
The
number
number
number
number
number
of children screened
who passed the screening
of children who failed the screening
of children who were referred for evaluation
of children who are receiving treatment
Michigan Department of
Community Health: Early
Hearing Detection and
Intervention (EHDI)
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.)
National and state initiative promoting
“1-3-6 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.
EHDI Report Card. How are we doing?
o
o
o
o
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.
LOSS TO FOLLOW-UP (LTF)
National LTF for 2010 = 39.4%
Birth
Year
2007
2008
2009
2010
2011
Referred
1925
1639
1518
1531
1557
LTF
1176
954
800
833
822
61.1%
58.2%
52.7%
54.4%
52.8%
*Number and percent of infants lost to follow-up after refer from final hearing screen: MI
EHDI Data, 2007-2011.
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.
Counseling Parents
“Your child may or may not have a
hearing loss…but let’s be sure about it.
If further testing shows hearing loss,
the earlier we get started helping the
child, the better.”
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
baby’s hearing. Let’s see if we can schedule
that appointment before you leave today.”
A Pass result Script
“Your baby has passed the newborn
hearing screen. However, your baby’s
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
baby’s doctor right away and ask your
doctor for a referral for a hearing test.”
What’s 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.
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 child’s 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.
Where’s Your Audiologist?
If you don’t already have a connection with a pediatric audiologist
in your community, you can call Michelle Garcia at 517-335-8878 or
contact her at [email protected] to receive help in finding one!
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.
By working together we
can give all babies born
in Michigan a better
chance at success.