Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs
Ear and Hearing
Yoshinaga-Itano, C., Carr, G., et al. (2024).
Ear and Hearing, 45(5), 1071-1088.
<div>This guideline provides recommendations for establishing early hearing loss detection and intervention (EDHI) programs. This article summary includes recommendations relevant to the field of audiology.</div>
Coalition for Global Hearing Health Hearing Care Pathways Working Group
<div>An EDHI care pathway should:</div>
<div>
<ul>
<li>include relevant stakeholders such as families, hearing professionals, deaf and hard of hearing (DHH) leaders, educational professionals, and policymakers;</li>
<li>integrate data tracking systems, quality assurance of programs, feedback loops, and fail-safe mechanisms to ensure participation and decrease loss-to-follow-up;</li>
<li>involve professionals with appropriate skills and competencies;</li>
<li>provide families and caregivers with comprehensive information at each stage;</li>
<li>publish and disseminate local policy and practice guidelines; and</li>
<li>follow best practices regarding screening, diagnosis, early intervention, provision of amplification, and resources and support for families and infants. </li>
</ul>
</div>
<div>Basic EHDI programs should abide by the 1-3-6 model as follows:</div>
<div>
<ul>
<li>provide hearing screening to all newborns within the first month;</li>
<li>identify hearing loss by 3 months of age;</li>
<li>start early intervention by 6 months of age; and</li>
<li>provide initial amplification by 6 months of age. </li>
</ul>
<div>Once a program consistently meets these recommendations, an intermediate EHDI program should strive to begin early intervention by 3 months of age. Advanced EHDI program should move to the following 1-2-3 model:</div>
<div>
<ul>
<li>provide hearing screenings to all newborns within their first month;</li>
<li>identify hearing loss by 2 months age; and</li>
<li>begin early intervention and provide initial amplification by 3 months of age. </li>
</ul>
</div>
</div>
<div>For infants born at home or not born in hospitals, EDHI programs should identify opportunities for universal hearing screening and follow-up at:</div>
<div>
<ul>
<li>wellness checks;</li>
<li>immunization clinics; and/or</li>
<li>genetic/metabolic screenings.</li>
</ul>
<div>These programs should identify the child's age at each point of contact. </div>
</div>
<div>For infants with hearing loss, amplification should be offered at the earliest age possible. If access to amplification technology is limited or unavailable, providers should: </div>
<div>
<ul>
<li>provide early intervention services immediately after confirming a hearing loss; and</li>
<li>provide additional visual communication approaches such as sign language or cued speech.</li>
</ul>
<div>Additionally, for infants with bilateral hearing loss with limited (e.g., only one hearing aid is available) or no access to amplification technology, providers should:</div>
<div>
<ul>
<li>determine which ear to fit using evidence-based protocols;</li>
<li>consider alternating the hearing aid between ears if the hearing loss is symmetric; and</li>
<li>plan to fit the other ear with amplification as soon as possible.</li>
</ul>
</div>
</div>
<div>When resources for amplification (i.e., ear molds, batteries) are limited or unavailable, EHDI providers should: </div>
<div>
<ul>
<li>explore low- and no-cost options;</li>
<li>investigate alternative options (i.e., repurposed earmolds, rechargeable solar batteries); and</li>
<li>monitor the efficacy of any adaptations as the child grows.</li>
</ul>
</div>
<div>Early intervention services should be family-centered. Support systems should:</div>
<div>
<ul>
<li>include diverse individuals who use different communication modalities, represent a variety of cultures, utilize assorted hearing devices, and/or have additional disabilities;</li>
<li>involve DHH individuals in the development and implementation of EHDI services;</li>
<li>include support from professionals and peers such as family-to-family and DHH professionals, leaders, and mentors;</li>
<li>train and support community leaders and teachers to provide early intervention services; and</li>
<li>offer teletherapy for supervision and mentoring.</li>
</ul>
</div>
<div>Sign language instruction should:</div>
<div>
<ul>
<li>teach the "indigenous sign language of the country" (p. 1081);</li>
<li>be provided by instructors with fluent or native signing skills, preferably by DHH instructors.</li>
</ul>
</div>
