1. Enhancing Communications Among Agencies Session 2 Kris Grbac, M.A., CCC-A. Missouri State University Springfield, Missouri Catherine Harbison, B.S.N., M.A. Missouri Department of Health and Senior Services Jefferson City, Missouri

2. Faculty Disclosure Information In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation. This presentation will (not) include discussion of pharmaceuticals or devices that have not been approved by the FDA or if you will be discussing unapproved or off-label uses of pharmaceuticals or devices.

3. Introduction Project: Round Table Discussions on Intervention Meetings held throughout the state. Topic: Intervention for newborns identified with hearing loss. Original purpose was to collect information on the process of getting newborns with hearing loss into intervention. Additional purposes developed over time.

4. Department of Health and Senior Services Department of Elementary and Secondary Education BACKGROUND INFORMATION ON MISSOURI

6. Characteristics of Missouris Part C Program Part C does not directly provide any service Service coordination and development of IFSP provided by contracted agencies known as SPOE (single point of entry) Service provided by independent providers who have enrolled as Part C providers BACKGROUND INFORMATION ON MISSOURI

7. Variables That Contributed to the Formation of Roundtable Meetings Inability to receive personally identifiable information (due to FERPA) from DESE re: enrollment in Part C, hearing aids, etc. Inability to receive personally identifiable information (due to FERPA) from DESE re: enrollment in Part C, hearing aids, etc. No reports from agencies (no requirement to do so) on intervention data elements and unusual occurrences, such as baby who passed birth screening but later was diagnosed No reports from agencies (no requirement to do so) on intervention data elements and unusual occurrences, such as baby who passed birth screening but later was diagnosed No relationship between DHSS and SPOEs No relationship between DHSS and SPOEs Unknown intervention resources in rural communities Unknown intervention resources in rural communities Families in contact with 4 different entities (audiologist, interventionist, DHSS staff and SPOE) Families in contact with 4 different entities (audiologist, interventionist, DHSS staff and SPOE) Many mild, conductive and unilateral hearing loss diagnoses (40%) Many mild, conductive and unilateral hearing loss diagnoses (40%)

8. Procedure: Planning and Completing the Meetings Invited audiologists, interventionists, SPOE staff and DHSS staff Invited audiologists, interventionists, SPOE staff and DHSS staff Solicited participants by email and phone calls Solicited participants by email and phone calls Planned first meetings for our biggest urban centers and surrounding rural areas Planned first meetings for our biggest urban centers and surrounding rural areas Scheduled meetings for 3 to 4 hours Scheduled meetings for 3 to 4 hours Provided free lunch

9. Procedure: Planning and Completing the Meetings Advertised meetings as true round table discussions – no formal agenda Provided participants with a list of topics that could be discussed and invited them to contribute additional topics

10. ST. LOUIS SPRINGFIELD KANSAS CITY COLUMBIA CAPE GIRARDEAU

11. Results: Attendance Good Attendance Good Attendance –100% of the invited audiologists attended –100% of the invited interventionists attended – 91% of the invited SPOE staff attended

12. Results: Topics Referral process to Part C Referral process to Part C Mild, conductive and unilateral hearing loss Mild, conductive and unilateral hearing loss Communication between agencies Communication between agencies Consent to release information from families Consent to release information from families Availability of intervention providers Availability of intervention providers Reporting procedures (from audiologists to DHSS) Reporting procedures (from audiologists to DHSS) Payment for hearing aids Payment for hearing aids

13. Results: What We Learned Missouris rural areas have very different concerns than the urban areas Missouris rural areas have very different concerns than the urban areas Newborns with bilateral moderate (or worse) sensorineural hearing loss in urban areas are receiving appropriate intervention Newborns with bilateral moderate (or worse) sensorineural hearing loss in urban areas are receiving appropriate intervention Intervention to newborns in rural areas is patchy Intervention to newborns in rural areas is patchy There is no uniform procedure or belief among audiologists, interventionists and SPOE staff regarding appropriate intervention for newborns with mild, conductive and unilateral hearing loss There is no uniform procedure or belief among audiologists, interventionists and SPOE staff regarding appropriate intervention for newborns with mild, conductive and unilateral hearing loss Some SPOE agencies were very confident in their ability to coordinate services for newborns with hearing loss, others admitted that they did not know what to do unless it was written in report Some SPOE agencies were very confident in their ability to coordinate services for newborns with hearing loss, others admitted that they did not know what to do unless it was written in report

14. Results: DHSS Actions in Response to Concerns Developed Guideline for Reporting for audiologists in response to their concern about knowing when to report Developed Border Babies document in response to audiologists concerns about how to report for babies who live or receive services out of state Revised a resource document on agencies and individuals who provide services to newborns with hearing loss in response to the concern that the document was out-of-date Worked with DESE to develop training materials for SPOE Staff

15. Additional Benefits Opportunity to meet people previously only known by phone and mail, form relationships and gain insight into all aspects of the EHDI process in Missouri Establishment of DHSS as lead agency Generation of ideas for enhancing program. Illumination of program areas that need work.

16. For more information: http://www.dhss.state.mo.us/NewbornHearing/ http://www.dhss.state.mo.us/NewbornHearing/