Successful Strategies for Improving EHDI Followup with WIC in Wisconsin

Anne B. Harris, PhD, Principal Investigator, University of Wisconsin – Madison.  Since 2011 the Wisconsin EHDI program, called “Sound Beginnings” (SB), has worked in collaboration with Wisconsin WIC agencies to reach infants at risk for lost to follow-up (LTFU) for newborn hearing screening (NHS). Overall, rates of LTFU have been decreasing in Wisconsin since the WIC NHS alert system was put into place. The purposes of this research project, conducted as a partnership between the state WIC/EHDI and UCEDD (“WEU”) are” 1) to evaluate the effectiveness of two intervention strategies implemented through a statewide WIC “alert” system to reduce the LTFU rates for hearing screening in Wisconsin, and 2) to describe and disseminate models of successful strategies for implementation in other states. The research protocol links NHS follow-up to WIC visits and involves all 70 WIC agencies in the state of Wisconsin.

Through an inter-agency agreement, a SB staff member identifies children enrolled in WIC who are at risk to be LTFU for newborn hearing screening from the EHDI database, and puts an NHS “alert” in the child’s WIC record to allow for different types of follow-up to be facilitated at the WIC visits, in coordination with the SB 3-Step Follow-up Process. The research design will test the efficacy of a WIC education and referral with SB parent-to-parent follow-up versus a more intensive follow-up strategy, which coordinates WIC visits with follow-up by a SB regional outreach specialist.

Update, August 2014. Baseline data have been analyzed to determine the impact of the WIC involvement in reducing LTFU rates, and if there are differences between the 2 strategies. Analyses to date indicate that approximately 360 babies each year over the last 3 years have been identified at high risk for LTFU, of which about 50% are enrolled in WIC. Whether enrolled in WIC or not, about 80% of those babies at high risk for LTFU have their NHS completed. However for babies enrolled in WIC, more intensive “care coordination” strategies are often being used to complete the NHS. These findings were disseminated through a presentation at the EHDI 2014 Annual meeting. Additional analyses are being completed to tease out the factors responsible for improved LTFU rates. As LTFU rates are dropping due to the 3-Step Followup process being used by SB, which includes the WIC partnership, strategies are being revised and implemented to determine what efforts produce the largest impact. Qualitative data are being collected to determine how families and WIC agencies perceive this NHS followup partnership.