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L.2 Texas Early Hearing Detection and Intervention (TEHDI) Process
The following is a list of processes for early hearing detection and intervention:
• Birth Screen: will be either screening auditory brainstem response (ABR), or transient or distortion product otoacoustic emissions (OAE):
•A newborn's hearing is screened at the birth facility. If a newborn does not pass the screen, hearing is re-screened before discharge.
•The birth facility reports results to the Department of State Health Services (DSHS) using the web-based eScreener Plus (eSP™) system.
•The newborn's family and physician/medical home receive a written report of the hearing screen outcome.
•If a newborn passes the screen, the physician monitors hearing as part of well child visits.
•If a newborn does not pass the second screen, a referral is made to a local resource for outpatient rescreen. See the following steps.
•Outpatient Rescreen: will be either screening by ABR or OAE:
•The physician/medical home receives the written report of results from the birth facility.
•The screener/physician reports results to the DSHS contractor, OZ Systems, using the web-based eSP system, by calling 1-866-427-5768, or faxing 1-214-631-4231.
•If the newborn passes the outpatient re-screen, the physician monitors hearing as part of well child visits.
•If a newborn does not pass (refers) the outpatient re-screen, a referral is made to an audiologist for evaluation using the Texas Pediatric Protocol for Evaluation. Visit www.dshs.state.tx.us/audio/assumpt.shtm for more information.
•For children whose families need financial assistance for testing, make an application to the DSHS Program for Amplification for Children of Texas (PACT). Consult the provider list at www.dshs.state.tx.us/audio/pactpro.shtm. Click on the area of the state and then on the city, or call 1-800-252-8023.
•Evaluation using Texas Pediatric Protocol for Audiology: will be diagnostic ABR and, if not previously done, OAE to verify cochlear involvement:
•Audiologists use equipment norms for newborns, preferably ones that they have collected on their equipment.
•Protocols include air and bone conduction results using tone burst ABR, as well as click ABR, so the amplification may be appropriately fit.
•The physician/medical home receives results and makes the referral to Early Childhood Intervention (ECI) using the web-based eSP system or by calling 1-800-250-2246.
•The physician/medical home monitors the child. See the American Academy of Pediatrics Position Statement at www.aap.org/policy/re9846.html.
•The audiologist reports results to the DSHS contractor as noted above and makes the referral to ECI.
•Includes the fitting of hearing aids by an audiologist when appropriate.
•Continue audiological assessment and/or monitoring as needed (usually monitor each three months for the first year of hearing aid use).
•Referral to an ECI program: will be performed by an audiologist or physician within two working days of identification of hearing loss as required by law:
•Service coordination provided by ECI.
•ECI will refer to the Local Education Agency (LEA) for auditory impairment (AI) services as outlined in the Memorandum of Understanding between TEA and DARS ECI.
•An evaluation and Individual Family Service Plan (IFSP) will occur within 45 days of referral to ECI.
•ECI and LEA services are available up to age three when determined by an IFSP.
•ECI and LEA will coordinate transition services upon the child's third birthday.
•The physician/medical home continues to monitor periodically: see the Joint Committee on Infant Hearing (JCIH) 2000 for suggested monitoring protocols at www.aap.org/policy/jcihyr2000.pdf.
•Deaf education and/or other special education services available from 3 to 21 years of age when determined by an individualized education program.
•Regional specialists from Deaf and Hard of Hearing Services at the Department of Assistive and Rehabilitative Services (DARS) will provide technical assistance to birth facilities, audiologists, and ear, nose, and throat (ENT) physicians to ensure reporting of screening and evaluation results. Provders can call 1-512-407-3250 for assistance.
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