1. Increasing Access to Hearing Screening for Out of Hospital Births

2. The Need to Focus on Out of Hospital Births

3. What was happening prior to having access to screening? Midwives would inform clients that their infants had not been screened and would refer the baby to hospitals or the pediatric provider of the family’s own choosing for evaluation and f/u. Hospitals had no protocols for addressing this population. Cost ranged up to $300 creating a barrier to low- income families Pediatric providers did not always have access to screening devices in their offices and did not refer for f/u Clients would not always bring their infants in to an MD for a check-up.

4. History of Efforts in WI In 2001 WI Sound Beginnings Program and WI Guild of Midwives –Raised money for 2 hearing screeners to be shared by many midwives (ABR) Initial success –Near 100% acceptance Equipment challenges –Cost of calibration and supplies –Delicate –Erratic Lack of sustainable funding

5. Act 279 enacted in 2009 “…nurse−midwife licensed under s. 441.15, or certified professional midwife licensed under s. 440.982 who attended the birth shall ensure that the infant is screened for hearing loss before being discharged from a hospital, or within 30 days of birth if the infant was not born in a hospital.” In April of 2009, the Wisconsin Sound Beginnings Program contracted with the WGOM to purchase hearing screening equipment and hire a Midwife “Champion” to provide training & program promotion

6. 2008 Hearing Screening Data Total Home Births on record: 813* (1150 actual) –Screened: 142 (17.5%) Passed: 140 (98.6%) –Not Screened: 671 (82.5%) * Total home birth count is based on the WI State Lab of Hygiene receiving a blood card for the child. WI’s EHDI tracking system is populated by the lab’s records and enables staff to track and follow up on babies who do not pass or are not screened. Babies without a blood card are not counted or viewable in the system.

7. 2009 Hearing Screening Data Total Home Births on record: 865* (same problem with data) –Screened: 66 (7.6%) Passed: 63 (95.5%) –Not Screened: 799 (92.4%) * Total home birth count is based on the WI State Lab of Hygiene receiving a blood card for the child. WI’s EHDI tracking system is populated by the lab’s records and enables staff to track and follow up on babies who do not pass or are not screened. Babies without a blood card are not counted or viewable in the system.

8. Hearing Screening Placement 10 Screeners have been placed in 2010. 9 purchased by WSB and 1 funded through a Children’s Miracle Network Grant.

9. Arrangements Equipment is owned by the Guild of Wisconsin Midwives More than 45 midwives have received training throughout the state One coordinator is assigned to each piece of equipment Equipment is shared amongst midwives Midwives pay into a fund $10 per baby screened in order to create sustainability (calibration and replacement costs)

10. 10 Recommended Out of Hospital Hearing Screening Protocol Provide parents are provided information about newborn hearing screening no later than the 36 week prenatal visit Difference between OAE and ABR screening are reviewed Parents are asked about family history of childhood hearing loss and referral to facility with ABR screening is made if family history is noted. Obtain parent’s consent or refusal to perform newborn hearing screening with OAE screener is documented Initial newborn hearing screening is performed at birth or within 3 days of delivery (no later than 2 weeks) If baby refers on one or both ears reschedule an OAE repeat screening preferably with in two weeks, but no later than 6 weeks 10

11. 11 If the Baby Passes on Both Ears Parents are provided with a checklist of normal developmental milestones for speech and language and are reminded that hearing loss can occur at any time Hearing screening results are documented: – in the midwives’ chart –on the newborn metabolic screening card, if hearing screening is done before or at the same time as the metabolic screen. If hearing screen is done after the metabolic screen has already been submitted, results are entered directly into WE-TRAC 11

12. 12 If Baby Refers on One or Both Ears If baby refers on one or both ears, midwives rescreen both ears within two weeks (no later than 6 weeks) If baby passes on both ears on rescreen proceed with documentation and parent education as outlined for a baby that passes on the initial screen If baby refers on one or both ears at the second screening, the need for further testing is discussed with the parents GBYS program is encouraged and referral is made A diagnostic appointment is made with a pediatric audiologist 12

13. 13 Referral Protocol If parent’s decline appointment with an audiologist resources for an ABR screen in a local facility is discussed as a possibility. If parent’s decline referral for local ABR screen or screen has not been completed within two weeks of referral offer the option of a home or office ABR screen done by the EHDI OOH Outreach Coordinator (or the midwife) If parent’s decline further testing case is closed as Refusal of Hearing Related care in WE-TRAC 13

14. 14 OOH Outreach Options Any case in which a baby has referred on a final screen and has not been diagnosed with a hearing loss within 12 weeks of the initial screen, will be followed up on by the EHDI OOH Outreach Coordinator (unless the parents have refused further testing) 14

15. For More Information Gretchen Spicer, EHDI Midwife Champion Office: 608-532-6464 Cell: 608-553-6464 Email: gspicer@mhtc.net