Newborn Hearing Screening Policy
POLICY: The West Virginia Speech-Language Hearing Association endorses the goal of universal detection of infants with hearing loss as early as possible. All infants, born within the state of West Virginia, with hearing loss should be identified before three months of age and receive intervention by six months of age.
PURPOSE: To provide institutions, organizations, and individuals involved with pediatric care with recommendations for best hearing care practice for newborns and young children.
- Considerations for Detecting Hearing Loss in Infants
- Technical Considerations
Techniques used to assess hearing of infants must be capable of detecting hearing loss of 30 dB HL and greater in infants three months and younger. Auditory brainstem response (ABR) and otoacoustic emissions (OAE) are two physiologic measures that are currently recommended to achieve this goal. WVSHA recommends that each team of health care professionals responsible for the development and implementation of infant hearing programs evaluate and select the technique that is most suitable for their facility.
It is essential that a team of professionals be involved in establishing and maintaining infant hearing programs. Ideally, teams should include audio logists, physicians and nursing personnel. Trained hospital personnel may conduct many aspects of the program which may include screening procedures and data management. It is recommended that a licensed audiologist be directly involved with the program as consultant in order to ensure appropriate test administration,training and follow up services for habilitation.
Program development and specific timelines should be established by each program to move toward the goal of identifying all infants, with hearing loss, born within the state of West Virginia. It is recommended that existing programs currently based on high risk factors continue to provide assessment services to infants in addition to a universal infant hearing program. They are useful in determining etiology of hearing loss and are essential in identify big those infants who require periodic hearing monitoring due to health conditions associated with hearing loss. A high risk program for identifying newborns with hearing loss should not take the place of a universal hearing screening program as high risk programs only identify a small percentage of those infants with hearing loss. Many infants with hearing loss have identifying risk factors. A list of high riskfactors associated with sensorineural and/or conductive hearing loss in neonates and infants will follow.
- Cost/Benefit Analysis
Each infant hearing program should develop a cost/benefit analysis associated with its specific protocol. This analysis should include the direct cost of identification and intervention. This information may be valuable in determining the savings that occur as a result of early detection and subsequent management of the child with hearing loss.
- High Risk Factors Associated With Sensorineural and/or Conductive Hearing Loss
To be used in conjunction with universal screening to identify those children at risk for developing hearing loss
- Family history of hereditary childhood sensorineural hearing loss
- In utero infection such as cytomegalovirus, rubella, syphilis, herpes, and
- Craniofacial anomalies, including those with morphological abnormalities of
the pinna and ear canal
- Birth weight less than 1,500 gram (3.3 Ibs)
- Hyperbilirubinemia at a serum level requiring exchange transfusions
- Ototoxic medications, including but not limited to the aminoglycosides, used
in multiple courses or in combination with loop diuretics
- Bacterial meningitis
- Apgar scores of 0-4 at 1 minute or 0-6 at 5 minutes
- Mechanical ventilation lasting 5 days or longer
- Stigmata or other findings associated with a syndrome known to include a
sensorineural and/or conductive hearing loss
- Parent/caregiver concern regarding hearing, speech, language and/or
- Head trauma associated with loss of consciousness or skull fracture
- Neurofibromatosis Type II or other neurodegenerative disorders
- Recurrent or persistent otitis media with effusion for at least three months
- Early Intervention Considerations
It is recommended that Ski*Hi, an outreach program of the West Virginia School for the Deaf, be named as lead agency in West Virginia to ensure tracking, referral and follow up services for those infants identified through the universal infant hearing program. Ski*Hi will serve as the point of entry for early intervention services in that Ski*Hi will make additional appropriate referrals for specific geographic areas to those Early Intervention providers who have been contracted with the Department of Health &Human Resources through the office of Maternal &Child Health. These comprehensive providers may facilitate access to needed services through a variety of community providers.
When an infant is identified as a child with hearing loss, early intervention services should be provided in accordance with the Individuals with Disabilities Education Act (IDEA), Part H Public Law 102-119. A multidisciplinary evaluation will be completed.
NBPT Equivalency Position Statement
Proposal: ASHA Certification of Clinical Competency (CCC-A, CCC-S) be accepted for Audiologists and Speech-Language Pathologists working in an educational setting as equivalent to National Board for Professional Teaching Standards (NBPT3).
Rationale: These specialization’s are net covered by NBPTS review and the attainment and maintenance of certification is a performance based process with significant cost.
- Educational audiologists and speech-language pathologists do not qualify for current or listed
certification by NBPTS.
- Quality service provisions are ensured by a number or performance based measures:
- AUD/SLP must complete a Master’s degree program from an accredited university/college, whose
program is reviewed by ASHA The clinical portion of ihe pre-service program includes 375 clinical clock
hours, of which 250 must be at the graduate school level and supervised by a professional with CCC.
- The AUD/SLP must pass a national examination from ETS
- The AUD SLP must complete an academic year of full time work, with a CF Y Supervisor who has CCC
and agrees to a supervision Plan which includes a number of specific indications of quality service.
- The AUD/SLP must abide by the ASHA Code of Ethics to maintain their CCC.
- There is a significant cost of $400+ to apply for CCC and > $150 to maintain CCC yearly.
- In addition to the benefit of the Local Education Agency (LEA) receiving quality services, qualifying for
financial support for certified personnel should help increase retention rates and decrease costs of hiring
and training new personnel.
Projected Cost: This will depend on the support funded m West Virginia and the number of educators with CCC-A/CCC-S who apply.
Medicaid Policy Statement
The West Virginia Speech Language and Hearing Association should be involved in the decision making process and providing input to the West Virginia regulating agencies and/or the West Virginia State Legislature on topics affecting the issue of Medicaid which includes, but is not limited to, eligibility criterions, fee schedules, and procedures for billing and reimbursement. These decisions affect the delivery of services and understanding of guidelines and procedures that insure appropriate services to West Virginians with communication disorders that receive services from members of the West Virginia Speech Language and Hearing Association. The Association should provide input to these agency(s) to promote understanding of the needs of providers and recipients of these services.
SCHOOL LICENSURE POLICY STATEMENT
The West Virginia Speech Language and Hearing Association believes that to help insure the quality of Speech Pathology and Audiology services in the West Virginia school system that all speech language pathologists and audiologists providing those services be licensed by the West Virginia licensing agency and maintain those licenses.