URLEND TraineesURLEND TraineesNancy Pajak (Wyoming)Nancy Pajak (Wyoming)

Becky Larsen (Utah)Becky Larsen (Utah)Nancy Dold (Montana)Nancy Dold (Montana)

Presentation Date – April 30, 2010Presentation Date – April 30, 2010

In the Beginning…

Problem: Newborn Hearing Screening (NHS) is not provided for all newborns

How do we reach those babies who are born outside the hospital setting?

Community health fairs, local clinics, midwives???

Community Health Fair

Advantage: Provide access to a larger population at one event

Challenges: Initial plan takes time in identifying stakeholders and establishing partnerships

As a leadership project, IRB approval may be necessary

The Great and Powerful IRB

Narrowing the Scope

“Even if we just identify one individual who needs hearing intervention, then we are making progress”

Reaching out to homebirth populations

Establishing a partnership with the midwife

Rationale:

The average rate of infants screened for the states within the URLEND region is 96.7% (CDC, 2007)

a sharp increase of births attended by midwives, either in the home or in a birthing center, from 1975 -2006 (National Vital Statistics Report, 2009)

Families who choose a homebirth environment will not have access to newborn hearing screening unless provided through the midwife attending the birth.

The State EHDI office will serve as a resource for education, training and equipment for the midwifery system.

The Leadership Project

Develop a system of NHS service through education, training and

providing equipment resources to midwives

Expand the number of newborn hearing screenings to families that choose homebirth environments

Provide hearing screenings within the home through the midwife to other children who may have not been screened

Identify children with hearing loss among the homebirth population

Create a working partnership between state EDHI offices and midwives within the state

Educate midwives and families in the importance of newborn hearing screening and early intervention for children with hearing loss

Foster and encourage hearing health for all members of the family

Project Objectives

First Step

Establishing a relationship with the midwife – midwives were identified in the Wyoming area for the purpose of the project

Establishing trust and creating a partnership

Developing a partnership network

Education and Training

Identified sources for educational and training materials – Literature review, National Center on Hearing Assessment and Management, Medical Home, and Utah EHDI training manual

Compiled a training guide: Newborn Hearing Screening: A Guide for the Midwife

A Guide for the Midwife

General Information

Newborn Hearing Screening Protocol

Diagnostic Follow-up and Early Intervention Resources

Frequently Asked Questions

References and Recommended Reading

First screening 24 hours after birth

If needed, the infant will be re-screened After the second screening, if the infant does

not pass, the infant will be referred for a complete audiometric evaluation

Contact information for facilities with complete evaluations is available for parents

Parents who choose not to have their infant’s hearing screened are required to sign a waiver form

Hearing Screening Protcol

Midwife Training at Walcott Junction, Wyoming

One midwife to do hearing screening after home births

Hearing screenings will be done 24 hours after birth

Otoacoustic Emission (OAE) equipment from the state EDHI program will be available for the midwife to use

While the training manual was helpful, the midwife

suggested changing some terminology to reflect a home birth model as opposed to a medical model.

For instance, the midwife believed that the terminology ‘refer’ indicated that the newborn should be referred immediately to the physician.

The midwife suggested using the term ‘fail’ instead. While there are problems with the implications of the use of ‘fail’, especially for the parents, the midwife does have a good point here.

Suggestions from the Midwife

Later, on the same day of midwife training, a prospective client asked the midwife whether or not hearing screening was part of the package of services

The midwife was delighted to be able to say that hearing screening was indeed a part of the services offered

A Fortuitous Event

The trained midwife gave the Wyoming EHDI program hearing screening training for midwives a favorable review!

She will encourage other midwives in Wyoming to train in newborn hearing screening

Further…

Practicing with the OAE equipment will

continue in June

The midwife will report… numbers of children screened recommended follow-up actions to the

Wyoming EHDI program names of children screened (with parental

consent)

Future Plans

Very valuable!

Attending clinics at Salt Lake City, Logan and Ogden

Attending Investing in Family Support conference in Scottsdale

Attending EHDI conference in Chicago Meeting others with similar goals and

aspirations and sharing ideas and plans

Reflections on the URLEND Experience

Our group agreed that leadership growth was

reflected in our collective journey through the Leadership Project

Appreciated most – the interpersonal connections that were made by the three of us

Three people – three different States (Wyoming, Utah & Montana) – have made connections for life and we know we could call on each other at any point in time for advice or help

Reflections on Leadership Growth

Future leadership activities really depend on

the overall goal of URLEND and the participant interests

Suggestion – perhaps five previous Leadership Projects should be selected as reading assignments at the beginning of the URLEND year

Reflections on Future Leadership Activities

The URLEND program is not for the faint-hearted!

This is a rigorous program with weekly readings and assignments as well as projects

Diverse group with various learning styles and experience

Suggestions: A module on conducting research (The great and

powerful IRB) A trainee mentor A list of readings and assignments before the first

seminar

Feedback on URLEND Program

Greater awareness was gained…

Hearing loss (etiology, prevention & amelioration, current trends)

Autism (current issues along with the changing inclusion criteria)

The Family (issues in raising kids with special healthcare needs)

Greater awareness will continue to inform future action and involvement

Feedback on Development of Leadership Skills under URLEND