Collaboration between WIC and EHDI to Improve Follow-up of Newborn Hearing Screen – Ohio

Lisa Hunter, PhD, Principal Investigator, Cincinnati Children’s Hospital Medical Center.  The overall goal of this proposal is to improve follow-up rates of infants who are referred from newborn hearing screening and enrolled in a targeted intervention group by implementing a highly integrated follow-up re-screening program for at-risk children in the Greater Cincinnati area (Hamilton County, Ohio) Women, Infants and Children (WIC) program. This work is innovative because it shifts the focus from searching for infants who have been deemed as “lost” to preventing the loss from occurring. Ohio’s EHDI system of Regionalized Infant Hearing Programs (RIHP), which track and follow children who did not pass their hearing screen, also provide Part C Early Intervention programming for children with permanent hearing loss.

Our primary aim is to test an intervention designed to increase the rate of follow through to desired outcomes of either a) passed screening test or b) completed follow-up diagnostic evaluation. We have designed a collaborative hearing re-screening program at WIC offices in Hamilton County, Ohio, modeled after a current pilot WIC re-screening project we are conducting in Butler County. Hamilton County has the largest number of referred newborn screening cases reported to the Ohio Department of Health and serves a needy demographic. We will use a comparison group sampled from similar birthing hospitals in the region, to test our hypothesis that a collaborative WIC hearing re-screening program significantly decreases the attrition rate of infants who fail newborn hearing screening.

Our secondary aim is to test whether the intervention decreases the time to receipt of a diagnostic audiologic assessment. Our hypothesis is that the collaborative WIC hearing re-screen program will significantly decrease the time between the hospital hearing screening and diagnostic evaluation. We will also ascertain the time to intervention for any children identified with hearing loss by following children after diagnosis to track time to enrollment in early intervention. In order to ensure that the program is optimally designed to reduce barriers to follow-up services, and meets the needs of the WIC population, we will also hold parent focus groups.

Update, August 2014: This project, designed to improve loss to follow-up rates in the Women, infant and Children (WIC) program, through collaboration with the Early Hearing Detection and Intervention (EHDI) program in Ohio, has now been implemented at four targeted birth hospitals in the Greater Cincinnati area that had a baseline average loss to follow-up rate of 48%. All WIC locations in Hamilton County and Butler are participating, and thus far, 75 infants have been enrolled. 100% of eligible parents who could be contacted have opted to enroll in the program, and 100% of enrolled infants have been successfully screened on-site at WIC locations. Approximately 8% of potential eligible infants could not be contacted, thus, loss to follow-up among eligible infants has been reduced from 48% to 8% in the first 6 months of the study. Because some infants may already be scheduled for diagnostic audiology prior to being seen at WIC, the project is collaborating with Cincinnati Children’s Hospital and the Neonatal Care Network to ensure that WIC re-screening does not take precedence or interfere with follow-up care already underway. Two community focus groups have been held, one with about 30 professionals and parents, and another with 20 parents and WIC providers. Both focus groups concluded that current newborn screening follow-up care suffers from lack of consistency, and insufficient public awareness about the benefits and need for timely follow-up. Additional community focus groups will be held during the second year, and telephone support versus in-person screening will be tested in additional hospitals.