Pediatric Medical Care

 

Why is Early Identification of Hearing Loss Important?

 

Congenital hearing loss is more common than any other condition at birth.  If left undetected, serious negative consequences are likely in the infant's development.  Research has confirmed that early identification of hearing loss by or before 6 months after birth is crucial for the infant's development of communication and linguistic skills. From the Department of Speech, Language, and Hearing Sciences at the University of Colorado-Boulder, Doctors Yoshinaga-Itano and Mah-Rya L. Apuzzo found that 26 month-old infants who were identified and provided services between birth and 6 months had "significantly higher levels of receptive and expressive language, personal-social development, expressive and receptive vocabulary, general development, situation comprehension, and vowel production.”

Evidence-based research shows the importance of providing early intervention as soon as hearing loss is identified. Also, just as important is for health-care providers to understand and be aware of the services and programs available for addressing the linguistic, communication, social, and cognitive needs of deaf and hard of hearing children.

 

 

1-3-6. Practitioners Guide

 

 

The Medical Home

The Medical Home is one of the core elements of the TEHDI process. This section will cover the Medical Home approach to health care for children who are deaf or hard of hearing. We will explore how to view provider treatment in a family-centered environment and how to develop a family/professional partnership within the Medical Home community. This section will define “confirmed hearing loss” and explain the timeframe in which newborns and infants should receive early intervention services.

What is a Medical Home?

A Medical Home is not a building, house, or hospital, but rather an approach to providing comprehensive primary care. Academy of Pediatrics (AAP) introduced the Medical Home concept in 1967, initially referring to a central location for archiving a child’s medical record. In its 2002 policy statement, the AAP expanded the Medical Home concept to include the following operational characteristics: accessible, continuous, comprehensive, familycentered, coordinated, compassionate, and culturally-effective care. The American Academy of Family Physicians (AAFP) and the American  College of Physicians (ACP) have since developed  their own models for improving patient care called the “Medical Home” (AAFP, 2004) or “advanced Medical Home” (ACP, 2006).

The Medical Home operates through professional partnerships with all health-care providers and stakeholders assisting the family and newborn.  The primary care provider assists the family by coordinating specialty care, educational services, in- and out-of-home care, family support, and other public and private community services. This coordination is extremely important to the overall health of the child and family.

A Medical Home should include:

• A partnership between the family and the newborn or infant’s primary health-care provider.

• Relationships based on mutual trust and respect.

• Connections to support services to meet the non-medical and medical needs of the child and family.

• Respect for a family’s cultural and religious beliefs.

• After-hours and weekend access to medical consultation.

• A sense of support in caring for their child.

• Primary health-care professionals coordinating care as a team with other care providers.

 

For families, having a Medical Home means:

• Receiving care for their child 24 hours a day, 7 days a week.

• Parents (or caregivers) are valued and respected members of their child’s medical team.

• The child gets the same doctor and office staff during each visit.

• The child can easily receive referrals to specialists or specialty care when medically necessary.

• The providers are familiar with the child’s health condition(s).

• The parents and their child are treated with ngenuine concern and compassion.

• A sense of support in caring for their child.

 

The following diagram illustrates how the components of the Medical Home work. In this model, the PCP is responsible for coordinating the team of specialists for the family. Making everyone involved aware of the Medical Home will promote a greater quality of service, with the central focus being on the child with hearing loss or suspected hearing loss.

 

 

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Why are Primary Care Providers Considered to be the Medical Home?

 

 

The PCP is the central active participant in the life of the family during the child’s first year. The primary care provider is the single most important member of the health-care provider team. The PCP is a source of continued support, from the initial evaluation through the well-child visits that assess growth, monitor developmental skills, and provide preventative care. The PCP’s relationship with the parents provides the greatest opportunity for family support and education. The PCP can also reinforce important messages delivered by the audiologist or others involved in the Medical Home.

 

By educating PCPs about the processes within the TEHDI program, early intervention can be dramatically improved for every child with deafness or hearing loss. The PCP supports the Universal Newborn Hearing Screening (UNHS) process by verifying that screening of all newborns is performed by 1 month of age, a confirmed diagnosis of hearing loss is made by 3 months of age, and assuring that infants receive early intervention services by 6 months of age as recommended by JCIH.

After a diagnosis of hearing loss is confirmed, the PCP should serve as a central referral source to other specialists. These specialists include: otolaryngologists [also known as ear, nose, and throat doctors (ENT)], audiologists, geneticists, ophthalmologists, early intervention specialists (including speech and language professionals), Deaf educators, and parent support groups. All of these specialists, along with the PCP and family, are included in the Medical Home for the child.  Additional roles of the Medical Home for children who pass the newborn hearing screen or have risk factors for late onset hearing loss include continued surveillance and screening. This includes assessment of auditory skills, developmental milestones, and attention to parental concern for their child’s hearing or language development.

 

The following diagram indicates the major principles a PCP should focus on when practicing the patient-centered Medical Home approach to care. The diagram is based on the Joint Principles of the Patient-Centered Medical Home released in March 2007.

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The 1-3-6 Month Practitioner's Guide outlines the steps within the TEHDI process, illustrating what occurs during each step of the process. The 1-3-6 Month Practitioner’s Guide is available by calling the Department of State Health Services TEHDI Program Coordinator at 512-458-7111, extension 7726.

How Does the Medical Home Fit within the TEHDI Process?

The Medical Home plays a critical role in supporting the follow-up of newborns and infants requiring services for susptected or diagnosed hearing loss. It is important to track newborns and infants who have not passed or did not receive the initial screening. These newborns and infants need to be promptly referred to outpatient screening within 1 month, as established in the TEHDI goals and  1-3-6 Month Practitioner's Guide.  A Medical Home for the family helps ensure that parents continue with the follow-up process.

What is the 1-3-6 Month Practitioner’s Guide?