Welcome to the training on Newborn Hearing Screening provided by the Texas Health and Human Services Commission (HHSC) and the Texas Department of State Health Services (DSHS).
Goal
The goal of this module is to equip Texas Health Steps providers and other interested health-care professionals to support the state’s newborn hearing screening program, provide follow-up and referrals for infants suspected of or identified as deaf or hard of hearing, and counsel families to help ensure that infants receive appropriate services.
Target Audience
Texas Health Steps providers and other interested health-care professionals.
Specific Learning Objectives
After completing the activities of this module, you will be able to:
- Summarize the implications of being deaf or hard of hearing and the benefits of early detection and intervention through newborn hearing screening and follow-up testing.
- Specify recommended, culturally sensitive methods for communicating with parents and caregivers about their infants’ hearing screening results.
- Assess best practices for promoting parental participation in hearing status identification and early intervention services for infants who are deaf or hard of hearing.
Note: In this course, the term "parent" also refers to guardians and other caregivers.
Please note this module expires on 7/31/2023.
This module was released on 7/31/2020.
Accreditation Statement
Continuing Medical Education
The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians.
The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.
Social Workers
The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Social Work Education.
Certificate of Attendance
The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.
Certified Community Health Worker
The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.25 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.
Disclosures
One of the requirements of continuing education is disclosure of the following information to the learner:
- Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
- Create a Texas Health Steps account.
- Complete on-line registration process.
- Thoroughly read the content of the module.
- Complete the on-line examination.
- Complete the evaluation.
- Commercial Support.
The THSTEPS Web-based Continuing Education Series has received no commercial support. - Disclosure of Relevant Financial Relationships.
The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose. - Non-Endorsement Statement.
Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center. - Off-Label Use.
Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).
The following are policies and definitions of terms related to continuing education disclosure:
The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.
All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.
Glossary of Terms
Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.
Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.
Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).
Browser Requirements
Texas Health Steps courses are best viewed using a current browser. If you are using an out-of-date browser or a version of Internet Explorer less than 11, lesson progress and interactive features may not function properly.
American Academy of Pediatrics. (2016). Textbook of Pediatric Care, 2nd edition.
American Academy of Pediatrics and the Centers for Disease Control and Prevention. (2014). Algorithm: Reducing Loss to Follow-Up/Documentation in Newborn Hearing Screening: Guidelines for Medical Home Providers.
Boys Town National Research Hospital
Centers for Disease Control and Prevention. (2019). Risk of Bacterial Meningitis in Children with Cochlear Implants. (Includes CDC and FDA recommendations.
Centers for Disease Control and Prevention. (2019). Congenital CMV and Hearing Loss.
Centers for Disease Control and Prevention. (2019). https://www.cdc.gov/cmv/clinical/index.htmlhtmlhtmlCytomegalovirus (CMV) and Congenital CMV Infection: For Healthcare Providers.
Culturally sensitive health care:
- U.S. Department of Health and Human Services, Office of Minority Health, Center for Linguistic and Cultural Competence in Health Care.
- Seven Steps to Become a More Culturally Sensitive Nurse.
- Cultural Awareness in Healthcare: A Checklist
Joint Committee on Infant Hearing’s Year 2019 Position Statement. Principles and Guidelines for Early Hearing Detection and Intervention Programs.
LanguageLine Solutions. Professional interpreters.
National Center for Hearing Assessment and Management. 2016 E-Book: A Resource Guide for Early Hearing Detection and Intervention.
National Institute on Deafness and Other Communication Disorders.
Texas Department of State Health Services. (2020). Screened Disorders fact sheets, including biotinidase deficiency and SCID.
Texas Department of State Health Services, Texas Early Hearing Detection and Intervention (TEHDI). 1-3-6 Month Practitioner's Guide and other Educational Materials for Health Professionals.
Texas Department of State Health Services, Texas Early Hearing Detection and Intervention (TEHDI). TEHDI and Early Childhood Intervention: Connecting Families with Services and other educational materials for health professionals.
Texas Department of State Health Services, Texas Early Hearing Detection and Intervention (TEHDI).
TEHDI Management Information System (TEHDI MIS).
Texas Department of State Health Services, Texas Early Hearing Detection and Intervention (TEHDI). Parental consent form for sharing information on the TEHDI MIS.
Texas Department of State Health Services, Texas Early Hearing Detection and Intervention (TEHDI). Resources for Parents.
Texas Department of State Health Services, Texas Health Steps. (n.d.). Hearing Checklist for Parents.
Texas Department of State Health Services, Texas Health Steps. (2018). Texas Health Steps Periodicity Schedule.
Texas Department of State Health Services, Texas Health Steps Online Resource Catalog. (Click on “Browse,” then “View Catalog Items,” then “Newborn Hearing Screening Program,” and then “Outreach Clients.”)
Texas Health and Human Services Commission. Early Childhood Intervention (ECI) information and referral form for physicians.
Texas Health and Human Services Commission. Early Childhood Intervention (ECI). Find your nearest ECI program.
Texas Health and Human Services Commission. Texas Health Steps. Child Health Clinical Record Forms.
Texas Medicaid & Healthcare Partnership. Texas Medicaid Provider Procedures Manual (TMPPM). Medicaid Managed Care Handbook, Section 2.5: Cultural Competency and Sensitivity, limited English proficiency.
Texas Medicaid & Healthcare Partnership. Texas Medicaid Providers Procedure Manual. (2014). Evaluation using Texas Pediatric Protocol for Audiology.
Texas Medicaid & Healthcare Partnership. Texas Medicaid Provider Procedures Manual (TMPPM). Online provider lookup.
Texas School for the Deaf. Statewide Outreach Center.
University of Texas at Dallas Callier Center for Communication Disorders.
U.S. Department of Health and Human Services, National Institute on Deafness and Other Communication Disorders (NIDCD). Fact Sheet about hearing aids.
U.S. Department of Health and Human Services, National Institute on Deafness and Other Communication Disorders (NIDCD). Fact Sheet about cochlear implants.
Boys Town National Research Hospital. (n.d.). Baby Hearing. Parenting a Child Who Is Deaf or Hard of Hearing, in English and Spanish.
National Institute on Deafness and Other Communication Disorders (NIDCD).
Parent Companion First Five Years, a bilingual website focusing on young children with disabilities. It was created to comfort, inspire and connect parents to helpful disability resources. http://www.parentcompanion.org/
- Relay Texas (7-1-1). Assistance with phone calls for people who have difficulty speaking or hearing.
- Texas Education Agency. Lists services for children who have difficulty seeing or hearing.
- Texas Education Agency (TEA). The TEA fulfills a requirement for a comprehensive statewide plan for educational services for students who are deaf or hard of hearing (DHH) through a State DHH Plan.
- TEA works in collaboration with:
- Its 20 Education Service Centers (ESC) around the state.
- ESC in Region 11 and its Deaf and Hard of Hearing State Leadership consultant.
- The Statewide Outreach Center (SOC) at the Texas School for the Deaf.
Responsibilities are divided:
- ESC Region 11 provides statewide leadership, professional development, consultation, and technical assistance to assist Regional Day School Programs for the Deaf (RDSPD), local school districts, charter schools and the Texas School for the Deaf (TSD) to address the unique needs of students who are deaf or hard of hearing. Visit the region’s website at: https://www.esc11.net/site/default.aspx?pageid=2372 functional 6/15/20
- SOC provides outreach support to schools and families. The SOC also provides information in Spanish on its website at
Legislation concerning “children with disabilities” in Texas can be found here:
- TEA’s local school districts also offer the Early Childhood Special Education (ECSE) program for children with hearing issues and other special needs, ages 3 through 5 years.
Texas Department of State Health Services. School Vision and Hearing Screening Program. Hearing and vision screening are mandated for children in child care, kindergarten, and 1st, 3rd, 5th and 7th grades. Children having difficulty with seeing or hearing will be identified early and linked to appropriate services. Results are reported to DSHS. Call DSHS at 800-252-8023, extension 7420.
- Texas Hands & Voices, a parent-driven organization that provides support to families with a child who is deaf or hard of hearing.
- Texas Health and Human Services Commission (HHSC) Services and Technical Assistance. HHSC’s Services for Persons who are Deaf or Hard of Hearing provides a variety of services to individuals and their families. It connects individuals who are deaf or hard of hearing to services and resources, including education, training, access to interpreters, information and demonstrations on assistive technology and much more. The goal is to eliminate societal and communication barriers and improve equal access to services for those who are deaf or hard of hearing.
Resource specialists also provide technical assistance to birth facilities, audiologists, and ear-nose-and-throat (ENT) providers to ensure reporting of hearing screening and evaluation results. Referrals to DSHS specialists can also be made by telephone at 512-438-4880.
Find more information on the HHSC web page for Services for Persons who are Deaf or Hard of Hearing.
- Texas Health and Human Services Commission. Deaf Blind with Multiple Disabilities Program. Applicable age: All ages. The DBMD program provides home and community-based services to people who are deaf-blind with multiple disabilities as a cost-effective alternative to institutional placement. The program focuses on increasing opportunities for consumers to communicate with others and interact in their environment. Call 877-438-5658 (use relay option of your choice to call, if needed).
- Texas Health and Human Services Commission. Early Childhood Intervention (ECI) services. Ages: Birth through 36 months of age. ECI is a statewide program that provides family-centered services, often in the home, based on the needs and concerns of the family. Service coordinators help families access and receive services and resource that support the child's development, including assisting with the transition to special education services or for children exiting ECI at age 3. ECI offers a web page with information for parents about available services.
- ECI Program Search.
- Texas Health and Human Services Commission. Programs for Children and Families, information for families about Medicaid and CHIP benefits and pediatric health-care services.
- Texas Health and Human Services Commission. Texas Health Steps, information about services.
- Texas Parent to Parent.
- Texas School for the Deaf. Ages: Birth through 21 years. Provides a continuum of direct educational services. Children birth through 35 months are provided services jointly with ECI. The school, residences and transportation are free to residents of Texas. 512-462-5353 (use relay option of your choice to call, if needed)
- Statewide Outreach Center (SOC) at Texas School for the Deaf (TSD). Provides services to deaf or hard of hearing individuals, from birth through 21 years of age, as well as their families. Works collaboratively with a variety of agencies, programs and schools across Texas to create a network of information, services and support designed to meet the needs of deaf and hard of hearing students, their families, and the professionals who serve them. Offers evaluation and assessment, referrals, consultation, in-service training, a lending library, and workshop and enrichment opportunities for families and students. 800-332-3873 (use relay option of your choice to call, if needed)
- UT-Dallas Callier Center for Communication Disorders.
- American Academy of Pediatrics. (2016). Textbook of Pediatric Care, 2nd edition.
- American Academy of Pediatrics. (2002, reaffirmed 2008). Policy Statement: The Medical Home. Pediatrics, 110:184–186.
- American Academy of Pediatrics and the Centers for Disease Control and Prevention. Algorithm on Reducing Loss to Follow-up/Documentation in Newborns: Guidelines for Medical Home Providers.
- Arnold, C. L., Davis, T. C., Humiston, S. G., Bocchini, J. A., Bass, P. F. III, Bocchini, A., … Forsman, I. (2006). Infant Hearing Screening: Stakeholder Recommendations for Parent-Centered Communication. Pediatrics, 117(Supplement 3), S341-S354.
- Berlin, E. A., & Fowkes, W. C., Jr. (1983). Cross-Cultural Medicine: A Teaching Framework for Cross-Cultural Health Care. The Western Journal of Medicine, 934-938.
- Boys Town National Research Hospital. (n.d.). Baby Hearing. Cochlear Implants.
- Centers for Disease Control and Prevention. (2019). 2017 Summary of Reasons for No Documented Early Intervention (EI) Services Among Infants Identified with Permanent Hearing Loss.
- Centers for Disease Control and Prevention. (2019). 2017 Summary of Diagnostics Among Infants Not Passing Hearing Screening.
- Centers for Disease Control and Prevention. (2019). Babies Born with Congenital Cytomegalovirus (CMV).
- Centers for Disease Control and Prevention. (2019). Congenital CMV and Hearing Loss.
- Centers for Disease Control and Prevention, Hearing Loss in Children. (2019). Genetics of Hearing Loss.
- Centers for Disease Control and Prevention, Hearing Loss in Children. (2019). What Is Hearing Loss?
- Centers for Disease Control and Prevention. (2019). Hearing Loss Treatment and Intervention Services.
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities. (2019). Hearing Loss in Children: Data and Statistics. https://www.cdc.gov/ncbddd/hearingloss/ehdi-data.html
- Delaney, A. M. (2018). Newborn hearing screening. Medscape.
- Dumanch, K. A., Holte, L., O'Hollearn, T., Walker, E., Clark, J., & Oleson, J. (2017). High Risk Factors Associated With Early Childhood Hearing Loss: A 3-Year Review. American Journal of Audiology, 16(2), 129-142. [Abstract]
- Healthy Hearing. (2020). Hearing Loss in Children.
- Healthy Hearing. (2015). Newborn Hearing Loss: From Prevention to Intervention.
- Hearing Loss Association of America. (n.d.). Conductive and sensorineural hearing loss.
- Joint Committee on Infant Hearing’s Year 2019 Position Statement. (2019). Principles and Guidelines for Early Hearing Detection and Intervention Programs.
- Korver, A. M. H., Smith, R. J. H., Van Camp, G., Schleiss, M. R., Bitner-Glindzicz, M. A.K., Lustig, L. R., Usami, S.,, & Boudewyns, A. N. (2017). Congenital hearing loss. Nature Reviews Disease Primers, 3, 16094.
- Mayo Clinic. (2020.) Cytomegalovirus (CMG) infection.
- National Center for Hearing Assessment and Management. Giving Your Baby a Sound Beginning video for parents and families.
- National Center for Hearing Assessment and Management (NCHAM). (2013). The National Early Hearing Detection and Intervention (EHDI) Landscape. Slide 7. Comparing hearing loss per 10,000 to other disorders detected in newborns.
- National CMV Foundation. (n.d.). CMV Prevention and Healthy Pregnancy Tips.
- National CMV Foundation. (2020). What is CMV?
- National Institute on Deafness and Other Communication Disorders (NIDCD). (2018). Auditory Neuropathy.
- National Institute on Deafness and Other Communication Disorders (NIDCD). (2017). Cochlear Implants.
- National Institute on Deafness and Other Communication Disorders (NIDCD). (2017). Hearing Aids.
- Pimperton, H., Blythe. H., Kreppner, J., Mahon, M., Peacock, J. L., Stevenson, J. . . . Kennedy, C. R. (2016). The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study. Archives of Disease in Childhood, 101:9-15.
- Texas Department of State Health Services. (2020). 2019 Healthy Texas Mothers & Babies Data Book
- Texas Department of State Health Services. (2020). https://dshs.texas.gov/newborn/screened_disorders.aspxaspxaspxScreened Disorders fact sheets, including biotinidase deficiency and SCID.
- Texas Department of State Health Services. (2020). Texas Early Hearing Detection and Intervention (TEHDI).
- Texas Department of State Health Services, Texas Early Hearing Detection and Intervention. (2019). Legislative Information.
- Texas Department of State Health Services, Texas Health Steps. (n.d.). Hearing Checklist for Parents.
- Texas Education Agency. (n.d.). Early Childhood Special Education programs.
- Texas Health and Human Services Commission. (2018). Texas Health Steps Periodicity Schedule.
- Texas Health and Human Services Commission. (n.d.). Deaf and Hard of Hearing Services.
- Texas Health and Human Services Commission. (n.d.). Early Childhood Intervention Services.
- Texas Health and Human Services Commission. (n.d.). Texas Health Steps forms.
- Texas Legislature Online. (2019). House Bill 2255.
- Texas Medicaid & Healthcare Partnership (TMHP). (2020). Texas Medicaid Provider Procedures Manual Children’s Services Handbook.
- Texas Medicaid & Healthcare Partnership (TMHP). (n.d.). Basic Provider Search.
- University of Texas at Dallas, Callier Center for Communication Disorders. (n.d.).
- U.S. Department of Health and Human Services, Office of Minority Health. (2019). Cultural and Linguistic Competency.
- Utah State University, National Center for Hearing Assessment and Management (NCHAM). (2020). A Resource Guide for Early Hearing Detection and Intervention.
The medical definitions in this module were adapted from the federal Centers for Medicare and Medicaid Services, Mayo Clinic, the National Institute on Deafness and Other Communications Disorders, the U.S. National Library of Medicine and WebMD.
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