North Dakota Early Hearing Detection & Intervention Program Review

Each day infants are discharged from the hospital at birth without receiving an initial hearing screening. By missing this critical opportunity, children are left out of the early identification and intervention process thereby potentially delaying their overall development. Improvements to state Early Hearing Detection & Intervention (EHDI) programs are credited to national recommendations, guidelines, and legislation. Statewide, North Dakota is doing its part to develop more effective EHDI models and address ongoing issues. One example is by using the data from the online statewide reporting system, OZ eSP, to show ND's hospital participation and program implementation. ND EHDI is excited to share 2006 performance results and data from the 2006 annual performance report.

Of the twenty-three birthing hospital partners in ND, six experienced changes in birthing capabilities or reported no births in 2006. By comparison, 17 of the 23 hospitals used the online reporting system consistently and 18 participated fully in the 2006 ND EDHI program. Four major cities and five hospitals accounted for the majority of ND births in these more populated areas. Hospitals experiencing more than 150 births per month are considered "large" hospitals and are not compared against "small" hospitals (< 150 births per month). Data presented are composite data and are anonymously compared. Eleven indicators were chosen to demonstrate performance of the ND EHDI implementation for the past year; however only three areas are discussed next.

ND compared its percentage of infants who did not pass (refer) their birth screen (OZ eSP data) with the national benchmark and found that ND is very close in meeting this goal. The national target suggests that of completed birth screens less than 10% should have a refer result. Last year small hospital data indicated that 10.95% of infants screened at birth needed additional testing. Similarly, large hospital data indicated 10.56% of infants needed additional tests and the state averaged 10.63% overall. These data assist EHDI staff and its partners to identify training or equipment needs thereby decreasing this percentage.

Tracking and follow-up of infants who do not pass needing an outpatient screen is an area of concern nationally and statewide. This is clearly emphasized by data presented through the OZ eSP system as well. Small hospital data indicate that 52.18% of infants who needed additional testing actually returned for a second-stage screen. Large hospital data showed 54.90% of infants returned. The goal is to eliminate loss-to-follow-up completely and assure that all infants who refer will actually return for additional testing. A 100% return rate for outpatient screens may seem unrealistic but research has confirmed that the earlier hearing loss is identified in a child's life, the more early intervention positively effects the child's development. By informing families of the importance of returning for an outpatient screen and providing support, the return rate will increase. Hospitals may need to employ new methods of appealing to families or continue to work with ND EHDI project staff to assist hospitals and audiologists to connect with community partners.

One such partner assisting ND EHDI efforts to reduce loss-to-follow-up is the Right Track Program. Right Track is a program funded through the Department of Human Services to provide parent education and necessary referrals to supporting programs. Another provider willing to assist is the ND School for the Deaf Parent Infant Program (PIP). PIP is a home-based program that provides parent education to families of children birth to three with a diagnosed hearing loss. PIP staff agreed to provide follow-up to families whose infant has not passed two rounds of hearing screenings. These providers assist hospitals by encouraging families of infants to return for any necessary hearing screenings.

Tracking and follow-up with infants who need a diagnostic evaluation is another area of focus for EHDI programs on a national scale. Last year, 57 infants referred for additional testing (12 by small hospitals; 45 by large hospitals) and only two were identified with having a hearing loss according to data reported in OZ eSP. In order to determine performance in this area for ND, the number of infants identified with a hearing loss in ND was compared with the national incidence level that 2-3 infants per 1000 are identified with having a hearing loss.

Vital Records reported that our partner hospitals birthed 9,587 infants in 2006 (1,631 by small hospitals; 7,956 by large hospitals). Using this metric, ND small hospitals should have identified 3-5 infants with hearing loss in 2006. Large hospitals should have identified 16-24 infants. According to the national incidence level, ND is under-identifying infants with hearing loss or possibly under-reporting. However, few audiologists have access to the statewide reporting system and those that do have access need training on reporting methods. The ND EHDI program is in its infancy in developing and implementing a tracking mechanism for those audiologists without OZ eSP access.

2006 OZ eSP data have illuminated both positive program indicators and some areas needing attention. ND EHDI staff and partners are using the online statewide system and can now show improved performance, prove service quality, and determine areas needing greater attention. As national guidelines and benchmarks evolve, ND EHDI will continue to work with our partners to address challenges in the early hearing detection and intervention process. To access the full report go to www.ndcpd.org/edhi, click on Resources, then 2006 Performance Report or call (800) 233-1737.