California Newborn Hearing Screening Program: Tracking Our Babies Lisa Satterfield, M.S., CCC/A California Department of Health Care Services Newborn Hearing Screening Program California Newborn Hearing Screening Program Hallie Morrow, M.D., M.P.H. Medical Consultant Jennifer Sherwood, M.A., F/AAA Program Audiologist V. David Banda, Chief Hearing and Audiology Services Unit Jeanne McGregor, Rachel Luxemburg, Cruz Naranjo, Staff Analysts California Program Statistics 2006 Program Data Total births: 563,522 Total screened: 425,638 76% of California births 98% of participating hospitals 270 birthing hospitals 175 certified outpatient screeners California Program Statistics Refer rate: 2.1% Miss rate: 0.3% Waive rate: 0.3% Loss to follow-up, 2005: 5% Loss to follow-up, 2006: 11% 1
California Program Statistics Identified with hearing loss: 919 Incidence 2/1000 Identified by 3 months of age: 515 (56%) Enrolled in Early Start: 669 (73%) By 6 months of age: 463 (69%) The Process of the CA NHSP WBN NICU* Outpatient Re-screen* Pass Refer Diagnostic Evaluation *ABR required for NICU Hearing Coordination Centers Geographic Service Areas Contractors who serve one or more geographic service areas Total Births by region (2006) Region A: 111,641 Region B: 97,082 Region C: 110,073 Region D: 240,602 2
HCC Responsibilities Hearing Coordination Center Staff Hospital Certification Quality Assurance Monitoring Director Audiologist Registered Nurse Clerical Support Parent Infant Tracking and Monitoring The HCC Role in a Perfect World If results are not received within 14 days of the scheduled appointment the HCC contacts the provider The HCC contacts family to ensure the appointments were kept and to determine the outcome Contact the family at scheduled intervals once hearing loss is identified: 1 week 2 months 6 months Tracking and Monitoring Manual Outlines the minimum expectations for the HCC Five Tracking Categories Outpatient Screen Required Diagnostic Evaluation Required Hearing Loss Identified Infant Transferred between hospitals Infant Resides outside of CA Provides HCC a framework to follow cases to their conclusion 3
Hospital Responsibilities Hospital Responsibilities Hospitals that have been certified by the HCC report individual results on babies that have: Referred Missed Waived Expired Transferred Been Determined Not Medically Indicated by a physician For infants who refer, the Hospital must: Schedule an appointment for outpatient screening Provide the family with appointment information at discharge Report the appointment to the HCC with inpatient screening results For infants who are missed, the Hospital must: Contact the family and schedule the follow up appointment Report the appointment to the HCC Communication Disorder Centers A CDC is a health care provider office or facility capable of providing audiology services to children. CDCs are approved for the following ages: Type A: children 5 years of age and older Type B: children 3 years of age and older Type C: infants and children of all ages Communication Disorder Centers Type C responsibilities: Comprehensive audiological evaluation and management Hearing aid evaluation and recommendations Hearing aid orientation Speech-language evaluation and remediation Comprehensive assessment and aural rehabilitative management Staff includes audiologist and speechlanguage pathologist with at least 1 year of pediatric experience 4
Early Start Single point of referral for children diagnosed with hearing loss Best Practices for Early Start for Infants and Toddlers who are Deaf or Hard of Hearing developed by the California Department of Education California Deaf and Hard of Hearing Early Start Workgroup Follow-up phone calls made by HCC Reality Check There are Barriers! Urban vs Rural Los Angeles County 10.3 million Alpine County 1260 Mobile population Migrant farm workers Mexican border Linguistic Diversity 20% of Californians have Limited-English-Proficiency 40% of Californians speak a language other than English in the home Barriers Diagnostic providers not scheduling appointments; waiting for families to call Parents not scheduling or no showing appointments Providers not submitting results Inconsistent communication to the parents Loss of infants through name changes, moves, and transfers And there s more Low payment for inpatient and outpatient screening Not enough qualified pediatric audiologists or programs producing them Delays in diagnostic authorizations Low reimbursement discourages providers from seeing children Delays in implementation of Data Management System 5
Navigating the Barriers Other solutions? Refer to local EPSDT program when unable to make contact with family Assist the family in getting the appointment Communication with the PCP Elevate problems with providers to state consultants Audiology bulletins to update providers Contact with state staff regarding authorization and claim difficulties How can state programs and community audiologists better serve the infant population? California NHSP Contact Information Thank you! Website: www.dhcs.ca.gov/services/nhsp Toll-free phone number: 877-388-5301 6