EHDI in Michigan. Introduction. EHDI Goals and Communication Options. Review of EHDI Goals. Effects of Universal Newborn Hearing Screening (UNHS)

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1 EHDI Goals and Communication Options Anita Vereb,, MS, CCC-A University of Michigan Division of Audiology Introduction Hearing loss is the most frequently occurring birth defect 2 out of every 1000 babies born in MI will have a significant hearing loss Hearing loss can cause severe delays in speech, language, social and academic skills Earlyarly Review of EHDI Goals Universal Newborn Hearing Screening (UNHS) - Screen by 1 month Hearingearing Normal or impaired? Detectionetection Diagnostic ABR and OAE by 3 months Intervention Begin by 6 months More than 90% of newborns were screened for hearing loss in the U.S % 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Jan-93 Jan-94 Jan-95 Jan-96 Jan-97 Jan-98 Jan-99 Jan-00 Jan-01 Jan-02 Jan-03 Jan-04 Jan-05 EHDI in Michigan Effects of Universal Newborn Hearing Screening (UNHS) Voluntarily screens >94% of babies per year. No legislation or mandate; none pending 100% Michigan birthing hospitals involved in universal newborn hearing screening Months Mean Age of Identification of Hearing Loss 2 0 Before UNHS After UNHS Dalzell et al,

2 Michigan Results In 1998 the incidence of reported hearing loss and average age of identification in the state of Michigan was 2 years of age. With the success of UNHS, MI EHDI data from 2004 has shown a decrease in the age of identification to 3.5 months!! Joint Committee on Infant Hearing Year 2000 Position Statement Survey data suggest that hospitals are successfully initiating UNHS; however, EHDI services including confirmation of hearing loss, fitting of amplification, and initiation of early intervention remain delayed (Arehart( et al., 1998) What we ve learned Only half of infants diagnosed with hearing loss are enrolled in Early Intervention programs by the time they are six months of age (ASHA, 2005). In Michigan, Early On reported data back to MDCH/EHDI re: enrollment in services on 66 % of the children referred to them through EHDI in Due to interpretation of Family Educational Rights and Privacy Act (FERPA) this has dropped to 39% in recent years. What we ve learned Early enrollment in intervention programs significantly advances language development in children with hearing loss (Moeller 2000). Intervention for hearing loss is most effective if initiated prior to six months of age (Yoshinaga( et al 1998). What we ve learned Decisions made for a hearing impaired child in the EI process will profoundly affect the child for his/her lifetime. Ability to communicate with others Academic setting Academic performance Role in society as an adult What is language? A systematic means of communicating ideas or feelings by the use of conventionalized signs, sounds, gestures, or marks having understood meanings - Merriam-Webster Online Dictionary A symbolic form of communication that involves, on the one hand, the comprehension of words and sentences and, on the other, the expression of feelings, thoughts, and ideas Encyclopaedia Britannica (2006) 2

3 Language serves as the foundation of reading and other academic skills. Language delays can result in poor academic performance, such as decreased graduation rates. 100% Lower academic achievement leads to fewer job opportunities and lower income: over half of the severe to profound hearing loss population have family incomes of less than $25,000 Combined Family Income Comparison: Severe-Profound vs. US Population 80% 60% 44% 40% 19% 20% 0% Did not graduate high school 5% 13% College Graduate Forty four percent of the severe to profound hearing loss population do not graduate from high school and only 5% graduate from college. 40% 35% 30% 25% 20% 15% 10% 5% 15% 10% 38% 26% 33% 36% 14% 29% Severely-Profoundly Hearing Impaired US Population Source: Project HOPE calculations from the National Health Survey 0% < $10,000 $10,000 - $24,999 $25,000 - $49,999 $50,000+ Severely to Profoundly Hearing Impaired US Population Source: Project HOPE calculations from the National Health Survey Limited income and limited job opportunities lead to greater dependence upon public assistance programs; the expected lifetime costs to society for a child with early onset hearing loss is $1 million. The good news is. 70% 60% 50% 40% 31% 40% 61% The effects of hearing loss can be minimized via early identification, early intervention, and appropriate habilitation 30% 23% 20% 14% 13% 12% 10% 6% 0% No Insurance Public Only Public/Private Private Only Severely to Profoundly Hearing Impaired US Population A majority of the severe to profound hearing loss population is covered exclusively under public insurance programs such as Medicare and Medicaid Early Intervention Should include a discussion regarding the goals the parents want to set for their child. What type of individual do they envision their child will be 20 years from now? In order to set goals, they need to be made aware of all of the possibilities. Yet, many professionals and parents are unaware of the possibilities and options available Recent IDEA Conference Report: Language on Parent Advisement Need for comprehensive, bias-free information Importance of early amplification and/or cochlear implantation Potential for age appropriate language in modality of parents choice Commends US Dept of Education for new parent brochure on options, technology, resources Available online at: ning_doors/index.html Order additional copies from: Publication ID# EH 0191 P 3

4 Early decisions. Communication Options Types of intervention No amplification (ASL) Hearing aid and/or cochlear implant Assistive listening devices FM systems Communication Options for Children Who Are Deaf or Hard of Hearing Communication Options Bilingual/Bicultural Total Communication Cued Speech Oral Communication Auditory-Verbal Reference: American Sign Language (ASL) Bilingual/Bicultural Manual communication hand shapes, location, movement, palm orientation Most often used by the Deaf community Has its own grammar, syntax, semantics and expression code English is taught as a second language, no written form of ASL Use of amplification is not a requirement for success with ASL Total Communication/ Signed Exact English Uses all means to communicate All methods are combined finger spelling, speech reading, sign language based on English grammar, baby signs, natural gestures Utilize hearing aids and/or cochlear implants Cued Speech Eight hand shapes called cues Cues represent different sounds of speech Helps tell the difference between voice and voiceless sounds p and b Combines speech reading, amplification and hand cues to learn to speak and develop language Auditory-Oral Emphasizes listening in conjunction with speech reading/lipreading to aid in communication Relies on the child making use of their residual hearing hearing aids, cochlear implants and FM systems Sign language not encouraged yet may use some natural gestures 4

5 Auditory-Verbal Child to rely on listening skills Stress consistent use of hearing aids, cochlear implants, FM system No manual communication, lipreading discouraged Caregivers are the primary teacher Sessions are 1 on 1 with the therapist involving the primary caregiver and child based on normal speech/language development Mainstreaming encouraged with normal hearing peers speech/language role models Additional Thoughts Parents can change options Families need to be involved no matter what option is chosen key to child s success Encourage families to visit various educational options available in their county/district Choices in Deafness : A Parents' Guide to Communication Options Edited by Sue Schwartz, Ph.D. $12.00 Amazon.com Early decisions. Communication Options Types of intervention No amplification (ASL) Hearing aid and/or cochlear implant Assistive listening devices FM systems No Amplification (ASL) Utilize a sign language interpreter if needed for intake evaluations and home visits Resources for families community college sign language classes DEAF C.A.N. Sign Language Services of Michigan MI Dept. of Labor and Economic Growth Division on Deafness Analog vs. digital Behind-the the-ear ear (BTE) and bone conduction aids Can be fit as early as a few weeks of age Can be fit for all degrees of hearing loss mild to profound Covered by CSHCS and some private insurance Hearing aids earmold BTE 5

6 Bone Conduction Hearing Aids/BAHA Cochlear Implants Used for children with atresia, microtia,, chronic middle ear infections HEARING LEVEL (db HL) j zv mdb n ng e l u i o a r p h g ch sh f th s AUDIOGRAM OF FAMILIAR SOUNDS FREQUENCY IN CYCLES PER SECOND (HZ) k Pediatric Cochlear Implant Candidacy FDA Pediatric Guidelines Age: 12 months to 24 months - profound sensorineural hearing loss in both ears Age: 25 months or greater - severe to profound sensorineural hearing loss bilaterally Minimal benefit from appropriate hearing aids No medical contraindications High motivation and appropriate expectations from the family Hearing aid trial months (*special consideration for post meningitis patients) Why use FM with a child? Demo HEARING LEVEL (db HL) z v j mdb n ng e l u i o a r p h g ch sh k S S S S S f th s Simulation of a Mild Hearing Loss w/ earplugs in place AUDIOGRAM OF SPEECH SOUNDS FREQUENCY IN CYCLES PER SECOND (HZ) 6

7 The Challenges of Hearing in the Home/Educational Setting Three major factors degrade the Signal-to-Noise Ratio (SNR) and therefore the quality of the speech signal: Background noise Reverberation Distance What is a wireless FM system? 2 1 1) The parent or primary speaker wears a wireless microphone called the transmitter 2) The child wears a miniature FM receiver. This receiver picks up the speakers voice. The receiver may be worn alone on the ear or attached to a hearing aid or cochlear implant Personal FM System Receiver Improvements in Technology Newer technology, such as digital hearing aids, cochlear implants, and FM systems provide children who are deaf/hard of hearing better access to sound. Potential to obtain speech/language and academic skills similar to those of children with normal hearing Microphone/Transmitter Keys to Success Informed and Involved Parents Early Identification Appropriate and Timely Intervention 7

8 Together we can make a difference! 8

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