17th ANNUAL EARLY HEARING DETECTION & INTERVENTION MEETING
March 18-20, 2018 • Denver, CO
3/19/2018 | 3:35 PM - 4:05 PM | Reducing Disparities and Improving Outcomes in Preschool Hearing Screening | Quartz A/B
Reducing Disparities and Improving Outcomes in Preschool Hearing Screening
The Office of Childhood Hearing (OCH) within the San Francisco Department of Public Health has conducted preschool hearing screening (PHS) on 5299 low-income 2-5-year-olds in urban childcares over the past 3 years. In Year 1, children were screened with pure-tone (PT) audiometry alone; in Years 2 and 3, otoacoustic emissions (OAEs) were added as an immediate backup screen for children who could not comply with behavioral audiometry. Addition of OAE reduced the number of children who were unable to be tested from 4.7% to 0.7%, thereby decreasing the referral rate from 8% to 5%, and improving the rate of detection of treatable findings among referred children from 19% to 53%. With PT testing alone, disparities in screening outcomes were noted with age, teacher concern, and home language, which were eliminated with addition of OAE. Follow-up after referral improved dramatically, from 36% to 91%, likely due to a decrease in unnecessary referrals (false-positive screens), which facilitated active follow-through and engagement between OCH, partner childcares, and parents. Overall rates of detection did not decrease with the addition of OAE screening, suggesting that the decrease in referral rate did not result in missed identification (false-negative screens). Of 3863 children tested using the two-stage, single-day PT+OAE protocol, 225 (6%) were referred for further testing, and only 17 (0.5%) were unable to complete testing. Of these referrals, 83% underwent follow-up audiologic testing: 29% were confirmed to have normal hearing, 49% had conductive hearing loss and underwent subsequent medical treatment, and 4.5% (11 children) were identified with sensorineural hearing loss. Our experience with a large, diverse, low-income community-based PHS program demonstrates the importance of OAE as a backup screen to increase referral quality, reduce disparities, and facilitate active follow-up and engagement with partner childcare centers and families, leading to improved outcomes.
- To learn evidence-based best practices in community-based preschool hearing screening
- To recognize disparities and challenges in community-based preschool hearing screening programs
- To learn strategies for improved outcomes and follow up in community-based preschool hearing screening programs.
Presentation:
15805_7847DylanChan.pdf
Handouts:
Handout is not Available
Transcripts:
15805_7847HayleyKriss.doc
Presenters/Authors
Hayley Kriss
(), San Francisco Department of Public Health, hayley.kriss@sfdph.org;
Hayley leads the Office of Childhood Hearing by conducting hearing screening in child care centers and non-SFUSD elementary schools, ensuring quality of audiometric practices in primary care, and collaborating with governmental agencies and community organizations to promote childhood hearing and speech. Ms. Kriss will provide the public health department with knowledge and skills she gained by working as: a newborn hearing clinician for Lodi Memorial Hospital, a school audiometrist for Center for Hearing Health, and a behavioral tutor for children with special needs. Hayley graduated several years ago from Sacramento State with a bachelor of science in Speech Pathology and Audiology. She has also earned licenses and certifications as a: Speech Language Pathology Assistant, Occupational Hearing Conversationalist, and School Audiometrist.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exist.
Nonfinancial -
No relevant nonfinancial relationship exist.
Elizabeth Cedars
(), University of California, San Francisco, Department of Otolaryngology-Head and Neck Surgery, elizabeth.cedars@ucsf.edu;
Elizabeth Cedars, MD, is a chief resident in Otolaryngology-Head and Neck Surgery at the University of California, San Francisco. She has an interest in public health and quality improvement, and has worked with the Office of Childhood Hearing in the San Francisco Department of Public Health for the past 3 years on quality improvement measures relating to the outcomes of their Early Childhood Audiometric Screening (ECAS) program.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exist.
Nonfinancial -
No relevant nonfinancial relationship exist.
Curtis Chan
(), San Francisco Department of Public Health, curtis.chan@sfdph.org;
Dr. Curtis Chan serves as Medical Director of Maternal, Child & Adolescent Health for the San Francisco Department of Public Health. He completed his medical degree, pediatrics residency, preventive medicine residency, and community health fellowship at the University of California, San Francisco (UCSF). He has served as attending pediatrician at UCSF, San Francisco General Hospital, St. Luke's Hospital, and San Mateo Medical Center, and Assistant County Health Officer in San Mateo County. He has worked closely with local governmental and non-profit agencies to promote health within parks and open space. He is engaged in many community health promotion activities, including lengthy service on the Board of Directors for Coleman Advocates for Children and Youth and the Boys & Girls Club of San Francisco. Curtis has received numerous local and national awards..
ASHA DISCLOSURE:
Financial -
Nonfinancial -
Dylan Chan
(), University of California, San Francisco, Department of Otolaryngology-Head and Neck Surgery, dylan.chan@ucsf.edu;
Dylan Chan, MD, PhD, FAAP, is Professor and Director of the Children’s Communication Center (CCC) in the Department of Otolaryngology – Head and Neck Surgery at the University of California, San Francisco. He received his PhD in Auditory Neuroscience from the Rockefeller University and MD from Weill Medical College of Cornell University. Dr. Chan completed his ONHS residency from Stanford University, followed by a Pediatric Otolaryngology fellowship at Seattle Children’s Hospital. He is the AAP EHDI California Chapter 1 Champion and Regional Network Liaison for the AAP EHDI program in California.
In 2014, Dr. Chan established the UCSF Children’s Communication Center, which is devoted to delivering multidisciplinary care for families of deaf and hard of hearing children, performing community outreach and education, and conducting clinical and translational research projects. By addressing existing shortfalls in care delivery and developing novel interventions, he hopes to significantly impact hearing health in children.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exist.
Nonfinancial -
No relevant nonfinancial relationship exist.