URLEND Trainees
Nancy Pajak (Wyoming)
Becky Larsen (Utah)
Nancy Dold (Montana)
Presentation Date – April 30, 2010
In the Beginning…

 Problem: Newborn
Hearing Screening (NHS)
is not provided for all
newborns
 How do we reach those
babies who are born
outside the hospital
setting?
 Community health fairs,
local clinics, midwives???
Community Health Fair

 Advantage: Provide access
to a larger population at
one event
 Challenges: Initial plan
takes time in identifying
stakeholders and
establishing partnerships
 As a leadership project,
IRB approval may be
necessary
The Great and Powerful
IRB

Narrowing the Scope

 “Even if we just identify
one individual who needs
hearing intervention, then
we are making progress”
 Reaching out to
homebirth populations
 Establishing a partnership
with the midwife
The Leadership Project

 Rationale:
 The average rate of infants screened for the states within the
URLEND region is 96.7% (CDC, 2007)
 a sharp increase of births attended by midwives, either in
the home or in a birthing center, from 1975 -2006 (National
Vital Statistics Report, 2009)
 Families who choose a homebirth environment will not
have access to newborn hearing screening unless provided
through the midwife attending the birth.
 The State EHDI office will serve as a resource for education,
training and equipment for the midwifery system.
Project Objectives

 Develop a system of NHS service through education, training and
providing equipment resources to midwives
 Expand the number of newborn hearing screenings to families that choose
homebirth environments
 Provide hearing screenings within the home through the midwife to other
children who may have not been screened
 Identify children with hearing loss among the homebirth population
 Create a working partnership between state EDHI offices and midwives
within the state
 Educate midwives and families in the importance of newborn hearing
screening and early intervention for children with hearing loss
 Foster and encourage hearing health for all members of the family
First Step

 Establishing a relationship
with the midwife –
midwives were identified in
the Wyoming area for the
purpose of the project
 Establishing trust and
creating a partnership
 Developing a partnership
network
Education and Training

 Identified sources for
educational and training
materials – Literature review,
National Center on Hearing
Assessment and Management,
Medical Home, and Utah
EHDI training manual
 Compiled a training guide:
Newborn Hearing Screening: A
Guide for the Midwife
A Guide for the Midwife

 General Information
 Newborn Hearing Screening
Protocol
 Diagnostic Follow-up and
Early Intervention Resources
 Frequently Asked Questions
 References and
Recommended Reading
Hearing Screening Protcol

 First screening 24 hours after birth
 If needed, the infant will be re-screened
 After the second screening, if the infant does not
pass, the infant will be referred for a complete
audiometric evaluation
 Contact information for facilities with complete
evaluations is available for parents
 Parents who choose not to have their infant’s hearing
screened are required to sign a waiver form
Midwife Training at Walcott
Junction, Wyoming

 One midwife to do hearing
screening after home births
 Hearing screenings will be
done 24 hours after birth
 Otoacoustic Emission (OAE)
equipment from the state
EDHI program will be
available for the midwife to
use
Suggestions from the Midwife

 While the training manual was helpful, the midwife
suggested changing some terminology to reflect a
home birth model as opposed to a medical model.
 For instance, the midwife believed that the
terminology ‘refer’ indicated that the newborn
should be referred immediately to the physician.
 The midwife suggested using the term ‘fail’ instead.
While there are problems with the implications of
the use of ‘fail’, especially for the parents, the
midwife does have a good point here.
A Fortuitous Event

Later, on the same day of midwife training, a
prospective client asked the midwife whether or not
hearing screening was part of the package of services
The midwife was delighted to be able to say that
hearing screening was indeed a part of the services
offered
Further…

The trained midwife gave the Wyoming EHDI program
hearing screening training for midwives a favorable
review!
She will encourage other midwives in Wyoming to
train in newborn hearing screening
Future Plans

 Practicing with the OAE equipment will continue in
June
 The midwife will report…
 numbers of children screened
 recommended follow-up actions to the Wyoming
EHDI program
 names of children screened (with parental consent)
Reflections on the URLEND
Experience

 Very valuable!
 Attending clinics at Salt Lake City, Logan and Ogden
 Attending Investing in Family Support conference in
Scottsdale
 Attending EHDI conference in Chicago
 Meeting others with similar goals and aspirations and
sharing ideas and plans
Reflections on Leadership Growth

 Our group agreed that leadership growth was
reflected in our collective journey through the
Leadership Project
 Appreciated most – the interpersonal
connections that were made by the three of us
 Three people – three different States (Wyoming,
Utah & Montana) – have made connections for
life and we know we could call on each other at
any point in time for advice or help
Reflections on Future Leadership
Activities

 Future leadership activities really depend on the
overall goal of URLEND and the participant interests
 Suggestion – perhaps five previous Leadership
Projects should be selected as reading assignments at
the beginning of the URLEND year
Feedback on URLEND Program

 The URLEND program is not for the faint-hearted!
 This is a rigorous program with weekly readings and
assignments as well as projects
 Diverse group with various learning styles and experience
 Suggestions:
 A module on conducting research (The great and powerful
IRB)
 A trainee mentor
 A list of readings and assignments before the first seminar
Feedback on Development of
Leadership Skills under URLEND

 Greater awareness was gained…
 Hearing loss (etiology, prevention & amelioration,
current trends)
 Autism (current issues along with the changing
inclusion criteria)
 The Family (issues in raising kids with special
healthcare needs)
 Greater awareness will continue to inform future
action and involvement