2011-01 Improving Early Hearing Detection and Intervention (EHDI) Loss to Follow-up/ Loss to Documentation through Screening at Women, Infants and Children (WIC) Certification Visits

All states have Early Hearing Detection and Intervention (EHDI) programs that help ensure all newborns are screened for hearing loss and infants who fail the screen receive appropriate diagnostic and intervention services. In 2007, hearing screening was documented among over 90 percent of infants born in the United States However, newborn screening is only the first step in the EHDI process. Diagnosis and provision of early intervention services are vital to the care of infants and children with hearing loss. Nonetheless, adequate documentation of timely diagnosis and initiation of effective intervention does not exist for many of these children. In 2007, approximately one half of infants who failed their hearing screening did not have a documented diagnosis reported to their state EHDI program. Additionally, documentation of receiving Part C intervention services (services for infants and toddlers provided by states through the Individuals with Disabilities Education Improvement Act of 2004) existed for only half of infants diagnosed with a hearing loss. These concerning numbers represent infants who might not be receiving appropriate services and are, therefore, at risk for language delays.

Women, Infants and Children (WIC) is a federal grant program administered by the United States Department of Agriculture (USDA) through state health departments.  This federal grant program provides funds to States for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.  WIC operates in 2,000 local agencies at 10,000 clinic sites in 50 State health departments, 34 Indian Tribal Organizations, the District of Columbia, and five territories (Northern Mariana, Samoa, Guam, Puerto Rico and the Virgin Islands).  WIC serves approximately 45% of all infants in the United States.

WIC's mission is to be a partner with other services that are key to childhood and family well-being.  In addition to providing nutritional supplementation services, WIC plays the role of an adjunct to services that provide immunizations.  The WIC Program's role in this capacity is to find out about a child's need for immunizations and share that information with parents, including where to get a child immunized. In 1996, after studies found improved rates of immunization among preschool aged children who received immunization referral linked with food-voucher issuance, CDC and the USDA joined together in recommending that state and local vaccination and WIC programs collaborate to ensure that young children receive immunization assessment and referral services.  In 2000, the White House Executive Memorandum was issued directing WIC to screen the immunization records of all infants and children under the age of two at WIC certification visits.

This public health collaboration between CDC and the USDA may serve as a model for establishing a nation-wide program that will reduce EHDI loss to follow-up.  However initial studies are needed to determine the effectiveness of food voucher issuance linked to EHDI follow-up assessment and referral.

Study Focus:

The purpose of this study is to determine if provision of WIC services in conjunction with EHDI follow-up assessment and referral is associated with improved loss to follow-up/loss to documentation rates.

The CDC/EHDI Team is interested in proposals that describe specific details of how EHDI follow-up assessment and referral will be gathered and administered within a WIC setting.  The successful applicant must provide documentation of collaboration between the State EHDI program and the State WIC program.  Specific WIC clinic sites that will function as a study site must also be identified and the applicant must provide documentation of their agreement to participate. The application must describe a protocol in which individualized (not aggregate) data for both infants who receive EHDI follow-up assessment and referral and infants who do not receive the intervention will be collected.  Data collected must include initial screening status, referral, diagnostic evaluation status and status of enrollment in early intervention.  The applicant must also have access to State EHDI data which includes items that identify populations at risk for loss to follow up such as type of insurance, race, ethnicity and maternal education.

Evaluation Criteria:

What components are critical to the evaluation of this RTOI?

 

Although a wide range of proposals may be considered, it is important that the applicant clearly outline the objectives and design of the study.

 

Successful applications must include the following:

1. Plans to establish collaborative relationships with involved stakeholders such as staff from state health departments, universities, or private organizations

2. Description of the research and analytic plan, including timeline of activities

3. Methods to be used to define and identify the study population

4. Description of benefits and barriers of identifying subjects and collecting data

5. Strategies to develop surveys and/or design focus groups (if the study design includes surveys or focus groups)

6. Anticipated participation rates for completion of surveys and/or focus groups (if the study design includes surveys or focus groups)

7. Plans for submission of progress and final reports, and dissemination of findings

8. Detailed budget, including identification of any sub-contractors

9. Protection of human subjects

 

Preferences will be given to applicants who:

1. Demonstrate knowledge of and experience with the proposed research methodology
2. Have prior experience in working with state EHDI and WIC programs
3. Have prior experience in conducting the specific research methodology proposed
4. Demonstrated history of their dissemination of research findings
5. Provide documentation of collaboration between the State EHDI program and the State WIC program. 
6. Identify WIC clinic sites that will function as a study site and provide documentation of their agreement to participate.
7. Describe a protocol in which individualized (not aggregate) data for both infants who receive food voucher issuance linked EHDI follow-up assessment and referral and infants who do not receive the intervention will be collected.  Data collected must include initial screening status, referral, diagnostic evaluation status and status of enrollment in early intervention.  Provide evidence of access to State EHDI data which includes items that identify populations at risk for loss to follow up such as type of insurance, race, ethnicity and maternal education.

 

 

A Letter of Intent (LOI) should demonstrate the researcher has an understanding of the issues surrounding hearing loss in the pediatric population, state EHDI systems, the state and local WIC programs and the specific type of methodology being proposed. The letter should also convey how the specific topic addressed relates to more general issues in public health.

 

The applicant should clearly describe all aspects of the proposed study, including (but not limited to) the justification for choosing the specific study topic, the precise methodology chosen with justification for using the methodology, and the analytic framework and statistical analyses that will be used. Collaborations with other partners, such as state agencies (the EHDI program and WIC program), universities, private organizations or local entities (the WIC clinic sites) the letter should indicate that these partners have been contacted and are willing to participate.

 

The LOI should:

• Provide an overview of the proposed research design and analytic plan.
• Provide evidence of anticipated collaboration that will be needed to achieve the study.
• Provide clear evidence of prior success collaborating with state EHDI programs and other public health staff.
• Clearly indicate experience with the proposed research methodology.
  
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