ABSTRACT 

Project Title:  	Guam EHDI Phase III - Reducing Loss to Follow-up after Failure to Pass Newborn Hearing Screening
Applicant Name:  	Heidi San Nicolas, Ph.D., Director 
       University of Guam Center for Excellence 
       of Developmental Disabilities Education Research and Service
Address:		Office of Academic Affairs, University of Guam 
   			UOG Station, Mangilao, Guam  96923
Contact Phone:		(671)735-2480 	FAX:(671) 734-5709 
E-Mail Address:	heidi.sannicolas@guamcedders.org
Web Site Address: 	www.guamcedders.org

The purpose of this project, Guam EHDI Phase III, is to meet the following needs in early hearing detection and intervention:  To reduce the number of infants loss to follow up between:  1) hospital and outpatient screening before one month of age; 2) outpatient screening and audiologic diagnosis before 3 months of age; and 3) diagnosis and entry into early intervention before 6 months of age.  This project will focus primarily on reducing the number of infants who are lost to follow-up following a failed hearing screening and to reduce the number of infants identified as high risk, who are lost to follow-up after failing to return for a 6-month follow-up hearing screening, with continued monitoring of lost to follow up for Diagnostic Audiological Evaluation (DAE) or placement for early intervention services.  The population served by Guam EHDI has been a major challenge in service delivery.  Multilingualism and multiculturalism present significant challenges in terms of communication and beliefs regarding pre- and post- natal follow-up and care, which are further exacerbated by the limited access to comprehensive health care on Guam. The Guam Department of Public Health and Social Services, Bureau of Family Health, Maternal Child Health Program (DPHSS) has requested the University of Guam Center for Excellence in Development Disabilities Education, Research, and Service (Guam CEDDERS) to continue to administer the Guam EHDI Project.  In this application six major goals have been identified with corresponding supporting objectives focused maintaining hearing screening rate at the 95% or better benchmark and to bring particular emphasis to locating infants loss to follow-up at all levels, so appropriate services can be made accessible.  The Guam EHDI Phase III will continue to develop Guam EHDI as an integrated, coordinated, and collaborative system that is supported in partnership with the DPHSS, Guam Memorial Hospital Authority (GMHA), Sagua Mañagu Birthing Center, and the Guam Public School System Guam Early Intervention System (GPSS-GEIS).  With the focus on lost to follow-up in this application, Guam will utilize the “Model for Improvement” advanced by the Institute for Healthcare Improvement (IHI) to test and implement new approaches in decreasing loss to follow-up. At the current time Guam has had varying levels of success with the recommended strategies found to be effective in the NICHQ learning collaborative.   Guam EHDI has identified several strategies that have shown to be promising in contributing to reaching all infants with potential hearing loss by decreasing the number of infants lost to follow-up.  With a significantly diverse and multicultural population of some 160,000, the challenge will be further compounded with the anticipated arrival of some 12,000 military troops and their support personnel that will be relocating from Okinawa to Guam. This and seven other challenges Guam is currently facing are listed and resolutions to these challenges which the  Guam EHDI team has outlined are presented.  Chief among these challenges is the lack of an electronic birth certificate system in place on Guam to assist with tracking and surveillance is discussed.  To assess Project performance, the evaluation consists of specific evaluation criteria which will shape the formative evaluation report, and constitute the annual grant performance report, and a summative evaluation which will examine the overall progress after the three-year grant cycle, and the status of integrating an enhanced data tracking and surveillance system designed to assist in reducing loss to follow-up at all levels.  A “lost to follow up” rate reduction projection is provided to set lost to follow-up rates over the next 3 years, with significant decreases anticipated each funding year.
Guam EHDI Phase III Project                                                                                                          1