From Colorado to Guam: Infant Diagnostic Audiological Evaluations by Telepractice

Article excerpt

This manuscript describes a pilot project in which infants in Guam who refer on newborn hearing screening receive diagnostic audiological evaluation conducted by audiologists in Colorado over the Internet (telepractice). The evaluation is completed in real time using commercially-available software and personal computers to control the diagnostic audiological equipment remotely, and videoconferencing with support personnel and the family. Test results for 9 infants, all of whom received complete diagnostic assessment by auditory-evoked potentials and otoacoustic emissions, are described. Further elaboration is provided on steps to establishing the project and how regulatory, privacy and confidentiality, and professional practice issues in telepractice are addressed.

Introduction

Early hearing detection and intervention (EHDI) programs are systems of services that diagnose infants who are deaf and hard of hearing by 3 months of age and enroll identified infants in early intervention by 6 months of age (Centers for Disease Control [CDC], 2012; Healthy People 2020, 2012; Joint Committee on Infant Hearing [JCIH], 2007). Component steps include newborn hearing screening (NHS), diagnostic audiological evaluation (DAE), medicai/otologie assessment, and early intervention. NHS is wellestablished in the United States and its territories. Summary of 2009 CDC EHDI data (CDC, 2009) demonstrated that of 47 states and 3 territories responding, more than 97% of infants born in those states and territories were screened for hearing loss at birth. However, more than 45% of infants in this data set who referred for further testing are categorized as either lost to follow-up (LTF) or lost to documentation of follow-up. In total, more than 25,000 infants who referred on NHS either did not have diagnostic audiological evaluations or diagnostic results were not reported to the jurisdictional EHDI program.

LTF substantially hinders public health and public education efforts to improve language and academic outcomes for children who are deaf and hard of hearing. Delayed confirmation of hearing loss in infants who are deaf and hard of hearing increases their risk for delayed speech and language development (Yoshinaga-Itano, Sedey, Coulter, & Mehl, 1998). For some families, especially those in remote or rural areas, LTF occurs when infant DAE services are unavailable in close proximity. In these cases, travel costs, geographic or weather-related travel barriers, loss of work time, and /or other family commitments may prevent infants from receiving timely services (Shulman et al., 2010).

LTF became increasingly problematic for the Guam EHDI program between 2009 and 2011. Guam, a U.S. island territory in the western Pacific, has a robust NHS program for infants born in the island hospital or birthing center (infants born on the U.S. naval base are not reported in Guam EHDI program statistics). During the period of 2009-2011, 99% of infants born in these facilities received NHS. In addition, Guam EHDI introduced a two-stage NHS program where infants who referred on inpatient otoacoustic emission (OAE) screening received outpatient automated auditory brainstem response (ABR) screening after discharge. The two-stage screening process reduced the percentage of infants who referred for DAE from almost 15% (442/2953 infants) to less than 5% (125/2732 infants) in 2011. During this same period, however, LTF for infant DAE increased from 7% in 2009 to almost 35% in 2011.

Lack of an audiologist on-island to provide extensive infant DAE services was the principle reason for the increase in LTF. This compromised infant enrollment in early intervention services. Without a diagnosis from a licensed professional, infants could not be confirmed as eligible for Individuals with Disabilities Education Act (IDEA) Part C services and could not be enrolled in an early intervention program. Part C provides financial assistance to states and U. …