Missouri's Newborn Hearing Screening Program

Cathy Harbison

Enacted on January 1, 2002, Missouri law requires hospitals to screen newborns for hearing loss prior to discharge.  When a baby is transferred to another hospital, the receiving hospital is responsible for the screening.  The law also mandates hospitals and audiologists to report the results of screenings, re-screenings and diagnostic evaluations to the Missouri Department of Health and Senior Services (DHSS) within seven days of the screening or test.  Lastly, the statute requires the DHSS to maintain a system of follow-up for all babies who miss or fail the initial hearing screening, and those who are diagnosed with a permanent hearing loss. 

Initial hearing screening results are reported on a two-part Newborn Screening Specimen Collection Form.  The hearing screening portion of the form is then removed and the newborn hearing screener writes the results of the final, inpatient newborn hearing screening in the remaining spaces. The results of an outpatient rescreen are placed on a separate hearing only form.  Results are recorded in a data base that includes bloodspot and hearing screening results.

State law requires hospitals to inform a baby’s parents and primary care physician (PCP) of the hearing screening results.  The DHSS sends up to two letters of notification to the parents of a baby who missed or failed the screening.   If no hearing screening results are received in two months, DHSS sends one letter of notification to the PCP.  Both letters encourage the parent or physician to take appropriate action.  Additionally, DHSS sends an informational letter to parents of children identified with a risk factor for late-onset hearing loss.  Finally, a referral to the Individuals with Disability Education Act (IDEA) Part C is made for every child who is identified with permanent hearing loss and recommended by their audiologist to receive early intervention.  DHSS also sends an informational letter to the parents of children diagnosed with a permanent hearing loss. 

Based upon the information shared with DHSS on diagnostic evaluation forms, most audiologists recommend genetic testing/counseling for children diagnosed with severe to profound hearing loss.  However, geneticists representing the two largest children’s hospitals in Missouri report that they see very few children with hearing loss.

Missouri’s Genetic Advisory Committee has a standing committee that advises the DHSS newborn hearing screening program.  Additionally, the State Interagency Coordination Council advises and assists the Missouri Department of Elementary and Secondary Education in the performance of responsibilities as stated in the IDEA Part C Program for infants and toddlers with disabilities.  Their responsibilities include identification of program supports and services, and promotion of interagency agreements.  

In order to secure accurate statistics regarding the early hearing detection and intervention (EHDI) process in Missouri, it is necessary to possess complete data.  Although Missouri has made great strides in the past two years in obtaining diagnostic data from audiologists, re-screenings completed in the offices of PCPs are irregularly sent to the DHSS.  The DHSS is attempting to rectify this problem through site visits, mass mailings, phone calls and offering flexible options for submitting results.

Additionally, the DHSS recognizes the importance of assuring that infants identified with hearing loss have immediate access to the expertise of professionals who are knowledgeable about hearing loss and can offer unbiased information regarding communication choices. Currently, Missouri is piloting a program in western Missouri that pairs such an expert in the unique needs of infants diagnosed with hearing loss with the Part C service coordinator who makes the initial visit to the child’s family.  Missouri Newborn Hearing Screening Program (MNHSP) is collaborating with the Missouri IDEA Part C program, First Steps (Missouri’s early intervention system for infants and toddlers with special needs) and the Missouri School for the Deaf to explore avenues for permanently implementing this program.

Early screening, identification and intervention are imperative to assure a child reaches his or her communication potential.  It is important for health care workers, audiologists, service coordinators and early interventionists to understand that collaboration and cooperation are necessary to ensure the EHDI process is completed in a timely manner.