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September, 2010                                                             Early Childhood Hearing Outreach (ECHO) Initiative
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Carefully Evaluate Before Contracting for Outside Hearing Screening Services

Most Early Head Start programs that are conducting Otoacoustic Emissions (OAE) hearing screening prefer to train their own staff to do the screenings themselves.  This enables children to be comfortably screened by individuals who are familiar to them, while also allowing the program to closely monitor all screening and follow-up steps to ensure completion within the recommended time frame.

A small number of programs, however, contract for OAE screening services from an outside service provider.   Although it can sound attractive to contract with an outside individual or group to fulfill the Head Start hearing screening performance standards, there are aspects of that arrangement that may not work well, especially when it comes to follow-up and program quality monitoring.

If you are considering contracting with an outside party to conduct your hearing screenings, be sure that you consider the following questions and have a clear, written agreement regarding:

1) What hearing screening method will be used?  Other than an assessment performed by a pediatric audiologist, the only reliable methods for conducting hearing screening with young children are OAE and pure-tone audiometry (which can be used with children 3-5 years of age who are developmentally mature enough to understand and follow directions).  The use of noisemakers or tympanometry alone are not acceptable screening practices.

2)  Who will track the children who do not pass the initial OAE screening, make a second screening attempt, and ensure that children who do not pass are referred to the appropriate health care provider to receive the necessary services?  Those who contract to provide hearing screening services are rarely willing or able to take responsibility for what happens after the initial screening.  For example, if a 2-step screening protocol is being implemented (as is recommended), the screener will need to rescreen every child who does not pass the first screening within two weeks.  Children who still do not pass must be referred promptly for medical/audiological services. You will need to monitor whether children are rescreened in a timely way by the contractor,  including children who may be absent on the day the contractor is present, whether parents are informed of the needed next step, and whether they make and keep the appointment with the health care provider.

3) How will rescreening after medical treatment and clearance be provided?   It is reasonable to expect that approximately 8-10% of children screened using a 2-step OAE protocol will need to be referred to a health care provider for a middle ear evaluation which often requires treatment for an ear infection. Once the ear infection has been resolved, and the pathway to the inner ear is clear, the affected ear(s) must be rescreened.  Health care providers treat ear infections, but are rarely able to complete an OAE hearing screening.  This means that the contractor must be available again at this point to rescreen a small number children in a responsive, timely manner.  In addition, children not passing the rescreen must be referred to an audiologist for a complete audiological evaluation, a critically important process that the Head Start program must monitor closely.   Without careful oversight, children who do not pass initial screenings can "fall through the cracks" and may never receive the follow-up diagnostic and treatment services they need.  

While not impossible, it can be very difficult to coordinate appropriate follow-up when an outside party is providing hearing screening services.  Unless all aspects of follow-up are planned carefully and agreed upon in detail, the initial screening may take place, but critical tracking and follow-up services may never be completed.  It is important for all involved to be committed to the concept that the primary purpose behind conducting hearing screening is to ensure that children who need medical and audiological services actually receive them. 

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What factors helped you decide to train your
own staff to conduct OAE screenings, or to contract hearing screening services from an outside individual or group?

As more Early Head Start programs address the important question of how to accomplish hearing screenings for all children they serve, it is valuable for them to learn from others' experiences.  Email us by clicking here to tell us what factors helped you make your programming decisions regarding whether your staff would learn to conduct OAE screenings themselves, or whether you would contract for those services.  We will incorporate this information into future resources we provide to programs facing this question.

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