Newborn Hearing Screening training and competencies: a dedicated and effective approach

Mrs Suzie Costello1, Ms Caris Jalla1Mrs Lara Shur1

1Earbus Foundation of WA, Wembley, Australia

 

Earbus Foundation of Western Australia’s Newborn Hearing Screening (NBHS) Program forms part of the National Neonatal Hearing Screening Framework. The Program commenced in October 2015 and currently provides NBHS in seven private hospitals across WA including St John of God (SJOG) Subiaco, SJOG Murdoch, SJOG Mt Lawley, SJOG Bunbury, SJOG Geraldton, Ramsay Health Joondalup and Ramsay Health Glengarry. This presentation shares the processes of training Screeners and highlights the rigorous competencies of our NBHS program.

A dedicated Screener is trained against the Western Australian Universal Newborn Hearing Screening Program Organisational Guidelines informed by the National Framework for Neonatal Hearing Screening. Each Screener is allocated to a setting with the sole role to work within this program. Training within Earbus includes standardised online training in conjunction with in-house training by our Director of Clinical Services and Audiologist. The NBHS Program has an assigned Program Manager who provides hands on training and ongoing support. Raw data from the screening equipment is routinely analysed by our Program Manager and incorporated towards ongoing improvements of the program.

Screener competencies are reviewed regularly and include Equipment Care and Infection Control; Communication Skills; Screening Technique; Administration and Record Keeping; Protocols; and Teamwork and Professionalism. In addition to these best practice guidelines and competencies, Earbus recruits Screeners based on aligned core values; to be Open and Honest; Loyal and Supportive; and Brilliant. Screeners have a role beyond the medical process with the task to also inform and educate parents. The interactions Screeners have with families impact the parental experience. To ensure these experiences are positive, our team are coached in communication – both in delivery and the information shared. Over the three years of our NBHS Program, Earbus have consistently met all KPI’s and continues to deliver quality newborn hearing screening in a cost effective way.

A two-way data transfer between screening- and follow up-instruments and tracking software

Mr Peter Böttcher1

1Path Medical, Berlin, Germany

 

Universal and quality controlled newborn hearing screening program requires a number of prerequisites for a long term, efficient and reliable outcome.

This includes a direct data transfer between instruments and tracking server.

Data transfer via SIM-card technology is to understand as “out of the box” solution, which is independent from any hospital IT-infrastructure.

Data is encrypted and transferred directly from instruments to a central database at the Tracking-Center. Mobile data networks are worldwide available, especially in areas with limited infrastructure.

Moreover, a nationwide screening program requires uniform settings, especially with respect to test-settings, risk-factors, applicable data fields, user-management and user-profiles.

The evolution from one-directional to bi-directional (two-way) data exchange has offered the possibility to configure all connected measuring devices from one central location.

In history when any configuration changes were required the employee had to visit the facility or the device had to be sent back to the service department. With bi-directional communication all settings can be made at the Tracking-Center, generating substantial saving in resources.

Programs in nations with long distances or limited infrastructure cannot provide personal on-site service, if for example a user has changed his or her name or login credentials. But even for distances in smaller regions such as Germany, the system is working more efficiently with bi-directional data exchange.

The independent wireless data transfer can be connected to all existing tracking systems. In combination with pathTrack software the functionality is available in different screening approaches, e.g. in preschool, newborn hearing screening or telemedicine.

The presentation illustrates the advantage of the telemedicine approach in screening programs as it is used in countries with long distances to medical professionals, like Iran, Chile or Mongolia.


Biography:

Peter Böttcher has worked as project manager for the implementation of a quality-assured universal newborn hearing screening in Hesse, Germany, Ministry of Social Affairs. The results were to a large extent decisive for the nationwide introduction of a mandatory NHS in Germany. He was founder of the Alliance of German Hearing Screening Centers. He exerts as consultant with the introduction of quality assured newborn hearing screening in various countries and works at PATH MEDICAL, Germany (developers of Echo-Screen, AccuScreen, Senti, Sentiero, NavPRO ONE). Peter Böttcher is a member of the WHO Stakeholders Group on Prevention of Deafness and Hearing Loss.

Audit of 10 years (313 successive infants) with congenital SNHL at an Australian tertiary children’s hospital, looking at the causation of the hearing loss.

Dr Laurence (larry) Roddick1

1John Hunter Children’s Hospital, The Junction, Australia,

2University of Newcastle, Newcastle, Australia

 

The presentation will outline the causes of SNHL as seen in an Australian paediatric tertiary referral hospital.

A cause was found in over 60% of the infants.

The different causes of the hearing loss and their percentage of the total number will be presented.

Conclusion – Total investigation of these infants is likely to yield a reasonable chance of finding the causation.  Howeve this figure will continue to get higher as genetic testing becomes even more available.


Biography:

Larry Roddick set up, and then convened, the infant hearing clinic at the children’s hospital in Newcastle NSW.  Any infant who did not pass the SWIS-H screens and then formal audiology was referred to the clinic.  The clinic covers all of northern NSW.

Larry is a senior staff paediatrician at the children’s hospital with 36 years experience as a paediatrician in the teaching hospitals in Newcastle.

Can a partnership really work?

Mrs Suzie Costello1

 1Earbus Foundation of WA, Wembley, Australia

 

This session introduces Earbus Foundation of Western Australia and how it collaborates with the Western Australian State Government and other providers to deliver the Newborn Hearing Screening Program under a partnership model in WA.

The presentation explores the diagnostic outcomes observed using the data collated over the three years of operation; discusses overcoming the practical challenges of operating a partnership model; provides an overview to the ‘intimate’ approach to parent management and demonstrates the cost-effectiveness of providing newborn hearing screening in this way.

The collaborative approach has ensured babies supported by this model have entered the early intervention pathway, where this has been necessary, well within three months of age. This model has application that may be beneficial to others.


Biography:

Suzie started her career working in a range of roles in the WA State Government Department of Community Services before moving interstate and internationally. Her experience has been in corporate business capacity across a number of sectors including health and community. Prior to Earbus was employed within a specialist Learning Support Unit in Edinburgh UK developing and delivering programs to children and adults with special needs and disabilities. Suzie is employed as the Newborn Hearing Screening Program Manager and is proud to be behind this stable, reliable and effective screening program for families birthing in private hospitals in WA.

Keeping staff connected 700km apart

Mrs Helen Burton1

1Victorian Infant Hearing Screening Program, Parkville, Australia

 

The Victorian Infant Hearing Screening Program (VIHSP) delivers state-wide newborn hearing screening to all eligible infants born or residing in Victoria both in public and private sectors.

This is a complex organisational undertaking.  There are 153 Royal Children’s Hospital (RCH) staff in the VIHSP team, 116 of whom are dedicated hearing screeners conducting hearing screens on newborns in over 70 birth hospitals state-wide, supervised by 22 locally based area managers. Staff are required to work within teams both locally and remotely with many providing newborn hearing screening services to multiple hospitals.

Despite multiple challenges associated with geographic distance, VIHSP strives to promote cohesion and sense of belonging among team members who can be located up to 700km apart. VIHSP have developed a range of innovative ways to maximise the efficiency and effectiveness of communication between staff members to promote staff cohesion and connectedness which include online training packages, online staff surveys, VIHSP staff newsletters, webinars, video conference meetings, online resources and VIHSP professional development days.

This paper aims to explore the challenges and benefits of implementing these strategies.

Staff retention rates, internal feedback and participation at professional development activities have been improved through such strategies, and will be described as measures of staff well-being and engagement


Biography:

Helen Burton has been part of the Victorian Infant Hearing Screening Program for over 10 years.  Helen has a background in Commerce/Corporate Governance and has worked in the financial, health research and public sectors and has a strong interest in organisational culture and effective communication.

Parent Feedback survey: what do you think of the service we provide to families?

Ms Victoria Rose1,3, Ms Florencia Montes2,3, Ms Anuja Limaye1,3, Ms Vivian Tran1,3

1Children’s Hospital Westmead, Westmead, Australia,

2Sydney Children’s Hospital, Randwick, Australia,

3Sydney Children’s Hospital Network, Westmead and Randwich, Australia

 

Aim:

As part of service improvement we have been conducting an online survey asking parents feedback about their experience with SWISH-Diagnostics, at both Randwick and Westmead Children’s Hospitals.

Methodology:

The survey covered a range of questions from waiting times, information received regarding the diagnostic process, the way the results were delivered, support provided, information and management plan, recommendations for improvement.

Results:

The response rate is 31% (41 respondents) and were are still collecting responses. Respondents were parents of babies with normal hearing and a range of hearing losses, some permanent some transient.

Comments from respondents showed overwhelming levels of satisfaction with the service.

Comments for improvement were the need to reinforce the presence of a support person, MRI conducted before seeing ENT

Main positive points were around the audiologist being calm, patient, caring, baby friendly

Conclusions:

It is reassuring parents are satisfied with the service provided. This survey has allowed us to identify areas for improvement.


Biography:

Victoria, Florencia, Anuja and Vivian work as Audiologists across the Sydney Children’s Hospital Network. They work with infants referred through the NSW State Wide Infant Screening Hearing Program (SWISH) to provide diagnostic assessment via Auditory Brainstem Response (ABR) testing.

Thinking small for success: Hutt Valley DHB’s Newborn Hearing Screening quality improvement journey

Sandra Hoggarth1, Kyle Bolland1

1UNHSEIP Program, Hutt Valley District Health Board, Lower Hutt, New Zealand

 

Hearing screening programmes typically focus on the big picture, for example in New Zealand our national programme monitoring targets (other than the 100% universal offer of screening) are typically and realistically some would say, set at around achieving 95-97% or better. At Hutt Valley DHB we have undertaken a series of improvement projects over several years with a focus on the small, the  3-5% of babies that for various reasons were not either starting or if started not completing the newborn hearing screening pathway.

This presentation is a summary of our journey through the challenges of DNA & decline under the lense of ethnicity, engagement, equity and access barriers – a shared experience across all newborn hearing screening programmes internationally. What we discovered worked and didn’t work along the way and the power that comes from putting the “baby patient” at the centre of everything we do. It aims to share some small ideas from a small urban screening programme that were big to our success.


Biography:

Sandra Hoggarth is currently employed as the coordinator for the Universal Newborn Hearing Screening and Early Intervention Program at Hutt Valley District Health Board offering hearing screening to 2000 families per year. Sandra has been involved with the program for 10 years being initially appointed in the role of team leader when the Hutt Valley program first started in 2009. Sandra is a qualified and current newborn hearing screener and national screener trainer.

Beyond Unilateral Hearing Loss (UHL) Diagnoses and Parental Grief

Ms Caris Jalla1, Mrs Lara Shur1

1Earbus Foundation of WA, Wembley, Australia

 

In the past UHL was considered to have little consequences because speech and language presumably developed appropriately with one normal-hearing ear. However, research has widely concluded that children with UHL have increased rates of speech delays, need for additional educational assistance and perceived behavioural issues. Children with UHL report lower in hearing-related quality of life, similar to children with bilateral hearing loss. Research has also reported that approximately half the number of parents undergoing the decision making process for intervention extremely stressful. This stress can be minimised with evidence-based education and support. Furthermore, children with UHL are often not prioritised compared to children with bilateral hearing loss and can easily fall through the cracks of services and intervention.

While the national adoption of newborn hearing screening has provided new opportunities for very early hearing loss interventions, it can also present difficulties or concerns for families; as commonly experienced with any diagnostic tests. Many families are met with emotions particularly when the hearing loss is unexpected. It is common for parents to experience sadness, anger, confusion, vulnerability and guilt. As a diagnostic service, it is typical for parents to express their worries and concerns when their child is first diagnosed with hearing loss.

In response to the need for greater UHL supports and resources, Earbus Foundation are establishing a resource centre and support group for families. This presentation will describe the experiences and identified needs of parents caring for children with UHL. The UHL program is co-designed with families, working towards upskilling parents in knowledge, capacity building and advocacy. An outline of the programs aims and outcomes will be shared. Parents raising children with UHL need support with understanding their child’s type of UHL, their likes, strengths and behaviours and more can be done to empower families beyond the diagnosis.

Family Violence is a health issue: UNHS response to family violence in Victoria

Ms Julie Castro1

 1Victorian Infant Hearing Screening Program – Royal Children’s Hospital, Parkville, Australia

 

In 2018, The Australian Institute of Health and welfare reported that intimate partner violence is the most significant health risk factor for women aged 25 – 44, with one in four women having experienced family violence.  In response to the Royal Commission into family violence, Victorian health networks have formalised their response to family violence experienced by both patients and employees.

The Victorian Infant Hearing Screening Program (VIHSP) hearing screeners and area managers meet over 400 women a day across Victoria, working in 40 health networks and at over 65 locations. The VIHSP work force is predominantly women.

The Royal Children’s Hospital (RCH) in Melbourne, which administers VIHSP, established a family violence working group that created family violence training opportunities and resources.  VIHSP prioritised family violence training as part of the mandatory bi-annual professional development seminars held in Melbourne for all VIHSP staff.

VIHSP staff were provided family violence training and were provided resources for responding to family violence and providing support for Employees and families. Operational managers created a family violence resource at each hearing screening office for staff use. Kept in a public space in the office, it highlighted the local resources within the region and how to utilise family violence leave.

Following implementation of family violence training VIHSP saw an increase in utilisation of the family violence leave and interest from managers on how about how to better support their team and patients. Given the success of these initiatives, VIHSP recommends UNHS programs undertake family violence training to support the work of the health networks to prioritise and respond to family violence.


Biography:

Julie Castro is a Senior Area Manager with the Victorian Infant Hearing Screening Program. Julie has a background in psychology and sociology, with a keen interest in how work place culture translates into work place practice. The Victorian Infant Hearing Screening Program (VIHSP) screens the hearing of newborn babies in their first weeks of life. The program aims to promote early detection and intervention to improve outcomes for babies with hearing loss.

It can be done! Objective testing on older children in natural sleep.

Ms Nicola Camporeale1

1The Royal Children’s Hospital, Melbourne, Australia

 

Electrophysiological methods of hearing assessment (Auditory Brainstem Response and/or Auditory Steady State Response) are widely used to define hearing for children who are not developmentally able to perform behavioural hearing assessments. Typically, these tests are used to assess infants and are performed in natural sleep.

What happens, however, when objective testing is required on babies and children who are considered “too old” for testing in natural sleep? Traditionally, we have turned to sedation or general anaesthetic to help us complete diagnostic assessment. Unfortunately, the complicated logistics of organising diagnostic assessments under sedation/anaesthetic mean that it is a lengthy process. This often delays diagnosis and early intervention, as families and specialists involved in the child’s care are in a “holding pattern” while they wait for conclusive results.

We propose that (in most cases) sedatives and anaesthetics can be avoided, thus facilitating a smoother pathway to intervention.

This presentation will give an overview of children >6 months of age who have completed testing in natural sleep at our clinic. We will also discuss the challenges faced by our Audiologists when attempting to test older children in natural sleep, as well as some helpful strategies to increase the likelihood of success.


Biography:

Nicola is a paediatric diagnostic audiologist at the Royal Children’s Hospital in Melbourne. Her special areas of interest are infant diagnostic testing, and the management of infants with permanent hearing loss.

Nicola has a Masters of Audiology from Flinders University, as well as a Bachelor of Psychology (Hons) from the University of Adelaide.

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About ANHSC

The Australasian Newborn Hearing Screening Committee aims to foster the establishment, maintenance and evaluation of high quality screening programs for the early detection of permanent childhood hearing impairment throughout Australia and New Zealand.

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