1996 Position Statement of the Directors of Speech and Hearing Programs in State Health and Welfare Agencies (DSHPSHWA)

Healthy People 2000 Objective 17.16: Reduce the average age at which children with significant hearing impairment are identified to no more than 12 months.

The Directors of Speech and Hearing Programs in State Health and Welfare Agencies endorse universal newborn and infant hearing detection as described by the Joint Committee on Infant Hearing 1994 Position Statement and the National Institutes of Health 1993 Consensus Statement on Early Identification of Hearing Impairment in Infants and Young Children. It is well recognized that the early identification of congenital hearing loss is paramount to normal speech/language, psychosocial, academic and vocational development in children. The National Institute on Deafness and Other Communication Disorders reports that hearing, speech and language disorders cost the United States economy an estimated $30 billion annually in lost productivity, special education and medical expenses. Also, it indicates that preventive and early intervention activities such as the early detection of hearing loss have the potential to save approximately 25% of the annual expenditure. Implementation of universal hearing screening will expedite the goal of early identification of hearing loss in a cost-effective manner.

Most states do not have an organized statewide newborn hearing screening program. (ASHA 1992) (Blake and Hall 1990) (Radcliffe 1993) Some states use a risk registry, which has a maximum potential of identifying only 50% of hearing impaired infants. (Mauk, et.al. 1991) (Mahoney and Eichwald 1987) (Stein and Kraus 1983) In practice, this number is greatly reduced by the fact that many children are lost to follow-up in most high risk programs. (Mahoney and Eichwald 1987)

The Directors of Speech and Hearing Programs in State Health and Welfare Agencies support the following:

  • The hearing of all infants should be screened in the first three months of life, preferably prior to hospital discharge.
  • It is recommended that either conventional Auditory Brainstem Response (ABR), automated ABR, or Otoacoustic Emissions (OAE) be used to screen for

hearing, with the consideration of new and improved techniques as they become available and are shown to be cost-effective and reliable.

  • The 1994 Joint Committee on Infant Hearing risk indicators should be

maintained as an adjunct to universal hearing screening and to monitor for late onset and progressive hearing loss.

  • Universal hearing screening programs should be community-based and familycentered to take advantage of existing resources and to maximize program effectiveness.
  • Universal hearing screening programs should be developed in conjunction

with physicians, nurses, hospital administrators, educators, speech-language pathologists, parents and the deaf community. Audiologists should coordinate, manage, or supervise these programs.

  • Appropriate intervention and follow-up, including Part H of the Individuals

with Disabilities Education Act (IDEA), should be an integral part of universal hearing screening programs.

  • The education of families and other caregivers, primary health care providers

and the general public is an essential part of early identification and follow-up services.

  • The financial support for universal hearing screening should be included in individual and group health insurance coverage and in national health care

reform.

  • State and national data bases for universal hearing screening need to be established. This will help determine accurate incidence and prevalence information, hearing loss demographics, and areas of need in prevention,

research and planning.

It is vitally important that public health agencies take a leadership role in implementing national universal newborn and infant hearing screening. This effort is consistent with the Healthy People 2000 Objective identified at the beginning of this document.

1996 DSHPSHWA Position Statement, Universal Hearing Detection, Page 2

References

American Speech-Language-Hearing Association. (November 1992). A survey of

State infant hearing impairment identification programs. Rockville Pike, MD.

Blake, P. and Hall, J. (April 1990). The status of state-wide policies for neonatal

hearing screening. Journal of the AmericanAcademy of Audiology,Volume 2. Number 2.

Elssmann, S.F., Matkin, N.D., and Sabo, M.P. (1987). Early identification of congenital sensorineural hearing impairment. The Hearing Journal. 40, 13 - 17.

Epstein S. and Reilly, J. S. (1989). Sensorineural hearing loss. Pediatric Clinics of North America. 36 (6), 1501-1520.

Joint Committee on Infant Hearing, 1994 Position Statement, ASHA. (December

1994).Audiology Today, 6 (6).

Mauk, G. W., White, K. R., Mortensen, L. B. & Behrens, T. R. (1991). The effectiveness of screening programs based on high-risk characteristics in early identification of hearing impairment. Ear and Hearing. 12,312-319.

Mahoney, T.M., and Eichwald, J.G. (1987). The ups and "Downs" of high-risk hearing screening: The Utah Statewide Program. Seminars in Hearing, 8. 155-163.

National Institute on Deafness and Other Communicative Disorders. (1989). A report of the task force on the National strategic research plan. Bethesda, MD:

National Institutes of Health Publishing.

National Institutes of Health. (1993). NIH Consensus Statement: Early Identification

of Hearing Impairment in Infants and Young Children. 11 ( 1).

Radcliffe, Donald. (April 1993). In Identifying hearing Loss in Infants, Time is of the

Essence. The Hearing Journal ,46, ( 4).

Stein, L., Clark, S. & Kraus, N. (1983) The hearing-impaired infant: patterns of identification and habilitation. Ear and Hearing. 4,232-236.

U.S. Department health and Human Services (HHS). (1990) Healthy People 2000: National Health Promotion and Disease Prevention Objectives.Washington, D.C.: Public Health Service.

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