1. Success in Minimizing Loss-to-Follow-up Hallie W. Morrow, M.D., M.P.H.

2. Challenges in California Size Diversity Mobility

3. Size Population of California 34,000,000 Population of Los Angeles County 9,500,000 Population of Alpine County 1,200

4. Size 540,000 Births per year 320 Birthing hospitals Largest – 7300 deliveries Smallest – 60 deliveries

5. Diversity Geographic Race/ethnic Linguistic

6. Geographic Diversity Large metropolitan areas

7. Geographic Diversity Large metropolitan areas Agricultural areas

8. Geographic Diversity Large metropolitan areas Agricultural areas Mountains

9. Geographic Diversity Large metropolitan areas Agricultural areas Mountains Desert

10. Geographic Diversity Large metropolitan areas Agricultural areas Mountains Desert Coastal

11. Race/Ethnic Diversity 47% Non-Hispanic White 32% Hispanic 11% Asian/Pacific Islander 6% African American 1% American Indian 3% Other

12. Linguistic Diversity 33% of Californians speak a language other than English in the home 20% of Californians have Limited- English-Proficiency 50% of low-income Californians have a primary language other than English.

13. Linguistic Diversity 1,570,000 students speak a language other than English in the home 105 languages are spoken in Fresno County schools

14. Mobility Urban Migrant workers Mexican border

15. Infrastructure

16. Interwoven with the Title V CSHCN and the EPSDT programs Inpatient and outpatient provider standards Hearing Coordination Centers Single point of referral to IDEA Part C

18. Hearing Coordination Centers Serve specific geographic areas Certify and re-certify hospitals as meeting standards Collect data Track appointments for individual infants

19. Hearing Coordination Centers Contact providers if no results are received Refer to local EPSDT program if infant no shows appointments or provider cannot contact the family

20. Hearing Coordination Centers Generate correspondence to infants PCP Contact all families of infants identified with hearing loss

21. Hearing Coordination Centers Assure referral to EI has been made Quality assurance monitoring

22. Referral to Early Intervention Created single point of referral for all California children 0-3 years of age with a hearing loss

23. Data Management No statewide data management system Each HCC developed Access database All infant information and results reported on paper reporting forms

24. California Program Data 2004 (Preliminary) 175 Hospitals participating

25. California Program Data 2004 (Preliminary)

28. Summary Infrastructure! Receive and review individual infant data in real time Take action if not getting appropriate services