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Behavioral Assessment of Hearing in 2 to 4 Year-old Children: A Two-interval, Observer-based Procedure Using Conditioned Play-based Responses
Published on: January 23, 2017
Evaluation of the universal newborn hearing screening and intervention program
Shanna Shulman1, Melanie Besculides, Anna Saltzman
1Blue Cross Blue Shield of Massachusetts Foundation, Boston, Massachusetts, USA.
Insights
Universal newborn hearing screening and intervention programs have improved infant hearing loss detection. However, significant barriers hinder follow-up care for infants who screen positive, impacting early intervention success.
Area of Science:
- Public Health
- Audiology
- Pediatrics
Background:
- Universal newborn hearing screening and intervention (UNHSI) programs have expanded nationwide, increasing infant hearing loss evaluations.
- A critical challenge for UNHSI programs is the loss to follow-up among families of infants who screen positive for hearing loss.
Purpose of the Study:
- To evaluate the progress of state and territorial UNHSI programs in achieving their goals.
- To identify persistent barriers to successful follow-up care for infants with positive hearing screens.
- To document successful strategies employed by states to overcome these barriers.
Main Methods:
- Surveyed 55 state and territorial UNHSI programs.
- Conducted site visits with 8 state UNHSI programs for in-depth evaluation.
Main Results:
- While screening has advanced, significant barriers impede linking infants with positive screens to necessary follow-up services.
- Identified barriers include insufficient service-system capacity, limited provider knowledge, difficulties for families accessing services, and information gaps.
- Documented successful state-level strategies addressing these identified barriers.
Conclusions:
- Programs have made progress in infant hearing screening but require improvements in linking families to follow-up care.
- Key areas for future improvement include enhancing data systems, ensuring medical home access, expanding provider capacity, developing family support, and promoting early detection awareness.
Abstract:
During the last 20 years, the number of infants evaluated for permanent hearing loss at birth has increased dramatically with universal newborn hearing screening and intervention (UNHSI) programs operating in all US states and many territories. One of the most urgent challenges of UNHSI programs involves loss to follow-up among families whose infants screen positive for hearing loss. We surveyed 55 state and territorial UNHSI programs and conducted site visits with 8 state programs to evaluate progress in reaching program goals and to identify barriers to successful follow-up. We conclude that programs have made great strides in screening infants for hearing loss, but barriers to linking families of infants who do not pass the screening to further follow-up remain. We identified 4 areas in which there were barriers to follow-up (lack of service-system capacity, lack of provider knowledge, challenges to families in obtaining services, and information gaps), as well as successful strategies used by some states to address barriers within each of these areas. We also identified 5 key areas for future program improvements: (1) improving data systems to support surveillance and follow-up activities; (2) ensuring that all infants have a medical home; (3) building capacity beyond identified providers; (4) developing family support services; and (5) promoting the importance of early detection.
