Guam Early Hearing Detection & Intervention (GEHDI) Logo

NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

A. EXPERIENCE TO DATE: 
To meet the purpose of the Guam Early Hearing Detection and Intervention (GEHDI) project, 
the following describes the progress to date on specific goals and objectives for Year TWO of 
the grant, significant achievements of the current budget year by budget category, and barriers 
encountered and strategies utilized to overcome the barriers. 

A.1 PROGRESS TO DATE: 
GOAL I: All infants will be screened for hearing loss before 1 month of age, preferably before 
hospital or birthing center discharge. 

Objective 1.1 GEDHI will work toward refining, strengthening, and implementing the infant 
hearing-screening program for all infants born on Guam. 

Objective 1.1 Progress to Date: 

The GEHDI project continues to monitor the implementation of the infant hearing program and 
to ensure that all infants born on Guam have access to a hearing screening prior to discharge 
from the hospitals or birthing center. In April 2003, two training sessions were held on 
“Reviewing Otoacoustic Emission and GSI 70, DPOAE Instrumentation” by Mr. Y’shua Yiseral 
and Mr. Dennis Triolo, Audiologists for nurses at the Sagua Mañagu Birthing Center. 
Henceforth, beginning May 2003, Sagua Mañagu began to implement infant hearing screening. 
In August 2003, training was conducted at the Naval Hospital with six nurses and nurse aids in 
attendance. Upon completion of the training, Naval Hospital began to implement the infant 
hearing-screening program at their site. As of August 2003, the all three birthing sites on Guam 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

are conducting infant hearing screening prior to discharge on or before 1 month of age. Based on 
the data collected on a monthly basis and the beginning date of implementation, Table 1 provides 
a summary of the number of live births, percentage of infants screened, and Not Screened by 
birthing sites. 
Table 1: Percentage of Newborn Screened 

Birthing Sites Implementation Dates # Live Birth % Screened % Not Screened 
GMHA Nov. 2002 – Jan. 2004 3039 75.9% 23.3% 
Sagua Mañagu May 2003 – Jan. 2004 377 90.9% 9% 
Guam USNH Aug. 5, 2003 – Jan. 04 210 85.9% 14% 

The data for GMHA indicates that 75.9% of infants born are screened prior to discharge and 
23.3% are NOT screened. The rate of screening at GHMA has improved 28% from the initial 
implementation in November through January 2004. For infants that are born at Sagua Mañagu, 
the data shows that 90.9% of infants born are screened, however for infants that either mother or 
baby have had complications during birth, they are immediately transferred to GMHA intensive 
care and are indicated under not screened which is refers to 7 out of 34 not screened or 25%. The 
Naval Hospital data indicates that beginning 82.8% of infants were screened prior to discharge 
and 17.6% of infants were NOT screened. Those infants not screened for August resulted in 
some babies born and discharged prior to the implementation of the infant hearing screening. In 
addition, 2 of the 35 infants not screened were immediately transported off-island for further 
medical treatment. 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

Objective 1.2 Culturally sensitive informational materials will be developed and disseminated 
regarding the importance of early identification and the infant hearing screening process. 

Objective 1.2 Progress to Date: The GEHDI project have developed brochures that provide 
families with information on the importance of infant hearing screening and the program. Each 
birthing sites have brochures tailored to their hospital or birthing center with the information who 
to contact. Furthermore, on a quarterly basis or if needed sooner, additional the brochures 
provided by the GEHDI project to ensure that all families are aware of the infant hearing 
screening program. As of February 2004, a total of ---brochures have been disseminated at the 
birthing sites and other health care facilities, families and service providers. In addition, posters 
were created to share information on the GEHDI project and the importance of hearing 
screening. A total of --- poster were printed and --- were disseminated to the community centers, 
mayor’s offices, churches, private and public health care facilities, and other public facilities that 
families frequent. Lastly, a pamphlet was created to give parents that return for a 2nd screen with 
additional information and details on infant hearing screening the importance of early hearing 
detection and intervention. Translated materials have been completed in Chamorro, Chuukees, 
and Tagalo. Materials translated in Korean, Pohnepeian and Japanese is scheduled for 
completion in June 2003 

Objective 1.3 Demographic data will be collected and will include fields such as race/ethnicity, 
mother’s level of education and insurance category. 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

Objective 1.3 Progress to Date: As of September 2003, the GEHDI Data Tracking System 
began to input information from each birthing sites with demographic information that included 
fields such as ethnicity and hearing screening results. However, mother’s level of education is 
ascertain when the infant fails the 2nd screen through a parent interview to gather more 
information about family history of hearing loss which is included a as part of the audiological 
protocol. 

Objective 1.5 GEHDI will develop systems that will reduce/eliminate financial barriers to 
screening. 

Objective 1.5 Progress to Date: The GEHDI brochures and posters have been disseminated to 
all birthing sites with information stating that hearing screening is free and if as a result of the 
screening further testing is needed, a referral to the appropriate early intervention system will be 
made and testing will be at no cost to the family. Informal meeting with the Lauren Duenas, 
Chief of Staff for the Senator Lou Leon Guerrero, were held to discuss the steps and processes 
needed to create and introduce legislation for infant hearing screening. In addition, meetings 
have been scheduled with local insurance agencies and policy makers to discuss cost for hearing 
screening as it becomes part of the standard of care for every infant born at GMHA and Sagua 
Mañagu. For military members, medical services is provided at no cost to the family and is part 
of the benefits of being an active, retired, or military civilian worker on Guam. 

Objective 1.6 Results of the hearing screening will be provided to the infant’s parents and 
medical home. 

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NARRATIVE PROGRESS REPORT 
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Objective 1.6 Progress to Date: Documented in the GEHDI Resource Manual as part of the 
screening protocol, results of the hearing screening are placed into the child’s medical records at 
all 3 birthing sites. For those that are referred for a 2nd screen, copies of the results are given to 
parents with an extra copy provided to parents for their physicians. For infants referred to the 
early intervention system, as part of their procedures, copies audiological reports are provided to 
their medical home upon release of information from the parent with an additional copy is given 
to the parents to share with their physician at the next baby checkup. 

Objective 1.7 GEHDI will clearly define the linkage system to ensure that all infants who do not 
pass the hearing screening will have an appropriate referral for diagnostic audiological 
evaluation. 

Objective 1.7 Progress to Date: AGEHDI Resource Manual was developed to clearly document 
the screening procedures to ensure that all infants that fail the initial screen at the GMHA and 
Sagua Mañagu parents are given information to call the Pediatrics Evaluation and 
Developmental Service (PEDS) center to schedule appointment for a 2nd screen. 

Objective 1.8 GEHDI will have an education/training plan for all service providers including 
screeners from both in-patient and outpatient areas, nurses and physicians. 

Objective 1.8 Progress to Date: The National Center of Hearing and Management provided 
technical assistance to the GEHDI project after our first year of implementation with a 2-day 
technical assistance visit by Yusnita Weirather on September 15 & 16, 2003. The purpose of 
Ms. Weirather's visit was to observe and provide training to nurses and nurse aids at the 3 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

birthing sites on screening techniques that could be used with newborns when conducting 
hearing screening that would result in better hearing results and to lower the referral rate. 
During the 2-day visit, Ms. Weirather conducted on-site visit at the Guam UNSH and at Sagua 
Mañagu with discussions centered on procedures for screening and hearing screening techniques 
to reduce the referral. More time was spent at the GMHA through training for 19 nurses on the 
OAE equipment and strategies for effective screening. In addition to working with the birthing 
sites, Ms. Weirather worked closely with the GEHDI staffs and offered strategies, techniques, 
and recommendation that would enhance and improvement our current system. 

Objective 1.9 GEHDI will have written screening protocols, including standard policies, 
procedures for screening, and appropriate forms. 

Objective 1.9 Progress to Date: The GEHDI project has developed a “Resource Manual” that 
documents written screening protocols, standard policies for each birthing sites, and procedures 
for screening. On January 18, 2003, the GEHDI Advisory Committee held its 1st quarterly 
meeting for 2004, and reviewed the policies and procedures for GMHA, Guam USNH, and 
Sagua Managua to ensure that all infants born on Guam will have access to a hearing screening 
prior to discharge. Currently, Sagua Managua and Guam USNH have existing policies and 
procedures in place to ensure that hearing screening is provided to every newborn as part the 
standard of care. GMHA has a draft policy and the Pediatric and Family Practice physicians 
during have reviewed procedures for newborn hearing screening that in May and October 2003. 
The first presentation was held on May 8, 2003 during the Pediatric Monthly meeting with 22 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

pediatricians in attendance. The second presentation was held during the “Family Practice” 
Monthly meeting that was held on October 23, and Family Practice Committee with 15 
physicians in attendance. As a result the recommendations and feedback during the meetings, 
modification and changes to the draft policy were made. The next step is for the Guam 
Interagency Coordinating Council (GICC) to review and approve the draft policy. Upon review 
and approval of the GICC, the GMHA policy and procedures will be forwarded to the 
Administrator and the Board for their final approval. With the implementation of the newborn 
hearing screening, Sagua Mañagu and Guam USNH have developed and have in place existing 
policy and procedures to ensure that infant hearing screening is part of the standard of care 
provided to every newborn. 

GOAL II: All infants who fail the screening will have a diagnostic audiological evaluation 
before 3 months of age. 

Objective 2.2 100% of all infants who fail the screening will receive a comprehensive 
audiological evaluation to confirm the infant/child’s hearing loss including type of impairment. 
Objective 2.3 Guam will identify linkages to assure that 100% of families who have an infant 
identified with a hearing loss will have appropriate referrals to medical, audiological, and 
intervention services. 

Objective 2.2. & 2.3 Progress to Date: The GEHDI Project monitors and tracks all infants that 
screen at the hospital or birthing center prior to discharge and if fail the 2nd screen are referred for 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

full audiological services. Table 2 shows the percentage of infants fail the initial screen at the 
hospital or birthing center and are referred to PEDS for a 2nd Screen. 
Table 2: Percentage Referred and Re-screened 

Birthing Sites Duration of Date Percentage Referral 2nd Screen Rate 
GHMA Nov. 2002 to Jan. 2004 55% 45.5% 
Sagua Mañagu May 2003 to Jan. 2004 44 % 69.5% 
Naval Hospital Aug. 5, 2005 to Jan. 04 14.3% Data incomplete 

Table 2 indicates that of the number of infants referred upon the initial screening from GHMA 
and Sagua Mañagu range between 40 to 50%. Furthermore, the return rate of infants for a 2nd 
screen is less than half of those referred from GMHA and around two-thirds of those referred 
from Sagua Managua. For infants that fail the 2nd screen at GMHA and Sagua Mañagu, parents 
are asked to schedule an appointment at PEDS for a 2nd screen. For those infants that fail the 
2nd screen at Naval Hospital a note is placed in the infant’s medical record and upon returning for 
the one-week infant check up with their primary physician, a 2nd screened is conducted. For 
infants that fail the 2nd screen at any birthing sites a referral is made for a full audiological 
evaluation to determine if there is a hearing loss. 
Table 3 shows the number of infants that were referred for a full audiological evaluation and the 
results of the evaluation. 
Table 3: 

No. Failed 2nd Screen No. Audiological Evaluation Diagnosis Lost to Follow-up 
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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

For those infants served at Naval Hospital upon completion of the audiological evaluation, a 
follow-up appointment is made through their primary physician and if determined with a hearing 
loss is referred to Navy Early Intervention Services prior to 6 months of age. However all other 
infant that fail the 2nd screen at PEDS are automatically referred to the Guam Early Intervention 
System and diagnostic evaluation is completed before 3 months of age and that an IFSP is 
developed and implemented prior to 6 months of age. Within the GEIS procedures, Service 
Coordinators will request consent from families to provide the primary physician or the medical 
home a copy of the evaluation and IFSP. 

Objective 2.4: GEHDI will develop and implement an education/training plan for the 
audiologist to ensure competencies in pediatric evaluation, management, and family counseling, 
and related topics. 

Objective 2.4 Progress to Date: Upon request made to NCHAM to provide technical 
assistance to evaluate the progress of the training, Ms. Yusinta Wierather, Consultant provided a 
two-day technical assistance visit to Guam in September. In addition to conducting training to 
nurses and nurse aides, she met with Mr. Dennis Triolo, Audiologist and the GEHDI Staff and 
provided recommendation for improvement. In addition to meeting with Ms. Weirather, the 
GEHDI Project supported training for Mr. Triolo to attend a 2-day workshop to enhance his 
skills in infant diagnostic audiology on ---- and --- . 

GOAL III: All infants identified with a hearing loss will receive appropriate early intervention 
services before 6 months of age (medical, audiological, and early intervention). 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

Objective 3.1 All infants identified with a hearing impairment and deafness will receive 
appropriate medical services before 6 months of age. 
Objective 3.2 GEHDI will ensure that all infants and children with a documented hearing loss 
will receive appropriate early intervention services from GEIS. Service coordination will be 
provided to all eligible children. 
Objective 3.3 All infants identified with a hearing loss will receive appropriate audiological 
services before 6 months of age. 

Objectives 3.1, 3.2, 3.3 Progress to Date: The GEHDI Data System will track all infant 
diagnosed with a hearing impairment and will be refer to the appropriate early intervention 
system. As part of the GEHDI procedures, family’s sign consent to have their infant screened 
and sign consent for their child to participate in the GEHDI Data and Tracking System. 

Objective 3.6 Families of children with an identified hearing loss will participate in the 
development of their child’s IFSP with team member that have knowledge, experience, and 
expertise on issues related to children with a hearing loss. 
Objective 3.7: GEHDI shall ensure that high quality early intervention systems are available to 
meet the need of diverse population and children with additional disabilities. 
Objective 3.9: GEHDI will ensure that 100% of parents/ families of children who have a 
hearing loss have an opportunity to participate in GEHDI. 

Objectives 3.6a, 3.6b, 3.7a & 3.9 Progress to Date: Numerous trainings were held this past 
year to support each component of the GEHDI Project. In June 27, 2003, training was provided 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

to the Department of Public Health and Social Services nurses on the GEHDI project with 13 
nurses in attendance. In September 15 & 16, 2003, Ms. Yusinta Weirather was the guest 
presenter during the GEHDI Advisory Meeting on September 15, 2003. In October 6 – 11, 2003, 
SKI-HI training was held with a total of 18 participants from GEIS, Navy EIS, DOE-Hearing 
Impaired Program, and CNMI EDHI Team in attendance Of the 18 participants, 13 participants 
received 3 credits from the University of Utah for completing the 45-hour training. Dr. Paula 
Pittman and Ms. Mary Woody were the instructors of the training. As a result of the SKI-HI 
training, a Guam SKI HI focus group was created to continue to work towards completing the 
action plan that was developed as of the training. Since the October 2003 training, the group has 
met 4 times and has conducted 2 trainings with on strategies for working with young children 
with hearing impairments and their families. The first training was held on November 21, 2003 
with the 25 Guam EIS staff participating and on December 5, 2003 with DOE Speech and 
Language Section with 15 speech and language therapist in attendance. In addition, 3 of the SKI 
HI members facilitated the January 20, 2003 parent-to-parent training. Training. 
There were six parent-to-parent meetings held this past year beginning with a Parent orientation 
held on August 13, 2003. The purpose was to share the information on the GEHDI project, for 
providers from Guam DOE (Hearing Impaired Program and GEIS) and Navy EDIS to share the 
mission and purpose of their program. In addition to networking, parents were given resources 
that to take home and if they wanted more information they could call the GEHDI office. There 
were 11 parents that were in attendance along with – service providers. On September 16, 2003, 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

Yusnita Weirater, conducted a parent meeting entitled: Some Babies Are Born Listeners 15 
parents were in attendance. On October 9, 2003, Dr. Paula Pittman and Ms. Mary Woodly, 
SKI-HI Consultants, shared information on the SKI-Project and the importance of early 
intervention a total of 9 parents were present. On November 17, 2003, Ms. Catherine McLeod 
and Dr. Merri Parson shared information on “Students Who are Deaf: Dispelling Myths with a 
total of 24 parents in attendance. On January 20, 2004, Lenny Josef, Navy EDIS, Vicky Ritter, 
GEHI Nurse, and Kiana Mendiola, Preschool Teacher facilitated the parent meeting entitled: 
What Happens Why You First Learn About Your Child’s Hearing Loss” with a total of 13 
parents in attendance. 

GOAL IV: All infants and children with late onset, progressive or acquired hearing loss will 
be identified at the earliest possible time. 

Objective 4.1 The hospitals and birthing center will refer all infants with high risk factors such 
as, family history of hearing loss, congenital prenatal infection, head/neck deformity, birth 
weight less than 1500 grams, hyperbillrubinemia, bacterial meningitis, asphyxia, mechanical 
ventilation, ototoxic medication, syndrome, etc. to GEIS. 
Objective 4.2: GEHDI will monitor the hearing status of all infants with at-risk factors for late 
on-set and progressive hearing loss 

Objective 4.1, & 4.2. Progress to Date: The GEHDI Project tracks infants at risk for possible 
late onset of hearing loss. As part of the Guam’s Individuals with Disabilities Education Act 
(IDEA) Part C State Plan, infants with risk factors are automatically eligible for early 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

intervention services and support. Infants with risk factors are recommended for hearing 
screening by 6 months of age. This procedure is included in the GEIS procedural manual 
updated in September 2002. Table 4 indicates the number of infants identified “at-risk” factors. 

GOAL V: All infants with hearing loss will have a medical home & parent-to-parent support. 

Objective 5.1 Each infant with a confirmed hearing loss will have an identified medical home 
before 3 months of age. 

Objective 5.1 Progress to Date: In the GEIS procedural manual updated in September 2002, a 
child’s developmental evaluation report and IFSP will be forwarded to the child’s medical home/ 
primary physician upon consent of the family. Furthermore, parents are given a second copy of 
the Audiological report and asked to provide this copy to their primary physician. 

GOAL VI: GEHDI will have a complete Tracking and Surveillance System to minimize loss in 
follow-up. 

Objective 6.1 GEHDI will convene an Advisory Committee to provide guidance on the 
administration, including collaborative efforts, and the effectiveness of GEHDI for implementing 
an integrated, universal, and collaborative hearing screening, evaluation, and intervention 
system for all infants born on Guam. 

Objective 6.1 Progress to Date: The GEHDI Tracking and Surveillance System was completed 
in August 2003. Currently, the system inputs the name, demographic information, and results of 
the hearing screening of every infant born at GMHA and Sagua Managua Birthing Center. 
USNH provides GEHDI with the data of number of births, newborns screened, and number that 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

receive 2nd screen. IN addition, USNA provides the names of those infants that are referred for 
full audiological evaluation. GEHDI Coordinator provides the Advisory Committee with a 
report on a quarterly basis of the number of live births, newborn screened, referred, passed, and 
not tested by birthing sites for review and input. 

A.2 SIGNIFICANT ACHIEVEMENT BY BUDGET CATEGORY: 
During the second grant year, positions, equipment, and supplies were purchased to support the 
implementation of the GEHDI Project. 
Key Personnel: The following GHEDI positions continue to be placed on the staffing pattern: 


. 
Elaine Eclavea, M.Ed., GEHDI Coordinator, is responsible for the overall planning and 
implementation, and oversees the operation and administration of the GEHDI Project. 
. 
William Toves, R.N., GEHDI Facilitator, was hired to provide GEHDI support to the 
hospitals and birthing center and is the liaison between the hospital, birthing center, and the 
GEIS, PEDS. 
. 
Victoria Ritter, L.N., GEHDI Screening Technician/Nurse’s Aide, was hired to support the 
registered staff nurses at the GMHA nursery ward and to support the project. Mrs. Ritter 
collects all the data on the hearing screening conducted at the hospital. 
. 
Ruth Leon Guerrero, GEHDI Secretary, provides secretarial support for the project. She 
assists in coordinating the Advisory committee and parent-to-parent meetings. Mrs. Leon 
Guerrero maintains the financial and programmatic records for the project. 
. 
Velma Sablan, Ph. D., GEHDI Evaluator, provides support in evaluating the project. 
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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

The following individuals have been hired on contractual basis: 

. 
Y’shua Yisrael, Audiologist, was contracted up until to leaving island in July 2003. 
. 
Dennis Triolo, Audiologist, has been contracted to provide support and on-site training at the 
hospital and birthing center on the use of and care for the GSI-70 Multi Patient Audiometers 
and provide audiological services to provide follow-up screening and audiological 
evaluation. Mr. Triolo, is currently the only audiologist on Guam. 
. 
Lana Leffingwell, Surveillance and Tracking Data Specialist, has been contracted to 
complete and train staff on the data tracking system. 
Equipment Purchased: To support the GEHDI data tracking and surveillance computer systems 
were purchased with File Maker Pro software that used in for the GEHDI System. 

Travel Request: Funds were used to cost share travel expenses for Yusnita Weirather, consultant 
from NCHAM to support the onsite two technical assistance on September 165 &16, 2003. 
Travel to support GEHDI Coordinator and Nurse Facilitator to attend the 3rd Annual Early 
Hearing Detection and Intervention Conference held in Washington D.C. February 16-22, 2004. 
Cost share training of Mr. Dennis Triolo, Audiologist to attend the Infant Diagnostic Audiology 
Workshop in Utah on ________________. 
Printing and Advertisement: With the increase funds allotted for public awareness of the GEHDI 
project, three brochures ---, poster ----, printed and disseminated to clinics, hospitals, churches, 
mayors offices, and high school parenting classes, and other public buildings that families are 
mostly likely to frequent. In addition, GEHDI advertisements were placed in the Managua 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

Magazine ---times. Other public awareness materials were purchased such as magnets, pens, 
bags. 
Facilities Rental: Facilities were rented for the ---Advisory Committee Meetings and Parent-to-
Parent Meetings held thus far. Interpreter services have been made available at every meeting to 
accommodate an Advisory Committee member with a hearing impairment. Parents that attended 
the Parent-to Parent Meetings were given a $25 dollar stipend for their attendance, in addition, 
transportation (gas coupons ) and childcare services were provided to enable parents to attend 
these meetings. Stipends were provided to local presenters that shared information and strategies 
with the parents during the meetings. Resource materials were purchased to support early 
intervention providers that work with young children with hearing impairments and parents. IN 
addition, the GEHDI office relocated to another office that provides more space for families to is 
come and research via the internet and or use the to borrow and any resource materials from the 
“Leading Library”. 

A.3 BARRIERS AND STRATEGIES: 
The GEHDI Project continues to work towards achieving the goals and objectives stated in the 
grant; however, there were barriers and challenges experienced that have resulted in 
Only 83.2% of infants screened prior to discharge, high referral rate for 2nd screen is between 40 
to 50 %, and lastly, lost to follow-up is at an average of 57%. In reviewing these barriers, an 
action was develop that includes the following activities: 1) Identification of a cohort of 
screeners at each birthing site that will be trained and observed by the GEHDI Facilitator and 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

Nurse aide to provide feedback on screening techniques. 2) These screeners will be given an 
opportunity to participate in 2nd screens at PEDS which would provide them additional 
opportunities to practice and enhance their screening techniques. 3) On a monthly basis, data on 
the number of infants screened and referred for 2nd screen will be reviewed by the GEHDI 
Facilitator and the head nurse of each site/ nursery and screeners to make any adjustments in the 
screening process and or techniques. Currently, two GEHDI staff are conducting all 2nd screens 
at the PEDS Center and commencing January 2004, Mr. Triolo, GEHDI Audiologist will begin 
to conduct 2nd screen at his clinic in hopes that better show rates will of family coming for the 2nd 
screen. 
An additional barrier that the delayed the implementation of the infant hearing program at the 
Naval Hospital was due to a change in personnel (Head of Pediatrics) and who had worked 
closely with the GEHDI staff to schedule training for nurses and to implement the infant hearing 
screening as a standard of care transferred off-island March 2003. After connecting with the 
Head of Nursery, training was then scheduled in August. To alleviate any barrier that may occur 
due to the high turnover rate of staff at the birthing sites, GEHDI Resource Manual will provide 
steps and procedures to be taken to include training, observation, and feedback of screeners. 
The reduction of personnel time of the GEHDI Facilitator, with the lost of nurses at the GMHA, 
Mr. Toves was unable to provide the GEHDI project with the .50 FTE specified in the grant due 
to the medical crisis that were occurring at GMHA. However, GMHA has hired additional 
nursing staff that would allow Mr. Toves to return to his .50 FTE . 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

B. SIGNIFICANT CHANGES: 
Due to the relocation of the Audiologist, Mr. Y’shua Yiseral, Mr. Dennis Triolo has taken 
increased his time as the only audiologist on Guam and provides training and audiological 
assessment under the GEHDI project. 

C. COLLABORATION: 
The GEHDI Advisory Committee has met five times from the initial implementation of the 
project. Representative in the Advisory Committee has been expanded to include the personnel 
Navy early intervention system and the Nurse Supervisor at Naval Hospital. In addition, the 
GEHDI Coordinator is working with the Department of Public Health and Social Services in 
facilitating the upcoming “Medical Home” conference that will be held this fall on Guam. 

D. MONITORING: 
During the each Advisory Committee meeting, GEHDI Coordinator shares progress to date on 
the goals and objectives stated in the grant and provide updated data on Tables 1 through 4. 

SIGNIFICANT FINDINGS: 
Lost of follow-up 
Training of GMHA Staff – to high referral rate 
Referrals to GEIS 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

Late on set 

2.1 objectives 
Parent-to-Parent Training 
F. RESPONSE TO CONDITIONS/RECOMMENDATIONS FROM MCHB: 
G. PLANS FOR THE UPCOMING BUDGET YEAR: 
Plans for the budget year 2003 – 2004 will remain as stated in the Grant application. Personnel 
will include the following key personnel funded by the grant: GEHDI Coordinator at .25 FTE; 
GEHDI Facilitator/Registered Nurse at .50 FTE; Screening Technician/Nurse Aide at .50 FTE; 
and Project Evaluator at .10 FTE. Travel will include an on-site technical assistance visit by 
SKI-HI consultant from the University of Utah, Dr. Paula Pittman that will provide follow-up 
training on the new SKI-HI Curriculum in Jun 2003. Bring out an off-island Audiologist/ 
Physician to serve as technical assistance/consultant to provide training and support to the on-
island Audiologists, primary care providers, nursing staff, and professionals providing medical 
homes for infants and young children with hearing loss. Funds will also be allocated for off-
island travel to support the GEHDI Coordinator, GEHDI staff, and a Parent to attends the annual 
national conference. Supplies for the audiometer, training materials and general office supplies 
will be procured to support the daily activities of the project. Contractual services are for 
audiological services from the only audiologist on Guam and contractual services for technical 
services in the development of surveillance and data tracking system. Contractual services for 

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NARRATIVE PROGRESS REPORT 
March 31, 2003 – March 30, 2004 

maintenance/repair of equipment; printing and advertisement and facilities rental will be needed 
for this coming budget year. Other budget items will include funds for communication, 
reasonable accommodations, and parent stipends. 
The activities outlined in the Project Activities Time Allocation Table are still on target and no 
changes are needed at this time. 


H. LISTING OF PUBLICATIONS AND OTHER MATERIALS: 
The following materials were created to support the GEHDI Project: The GEHDI Advisory 
Committee Resource Binders, which organizes grant information, research on best practices, and 
GEHDI goals and objectives, and meeting notes. This Resource Binder was provided to each 
member and is updated quarterly with minutes of meetings, presentation slides and updated 
research information. Three GEHDI Brochures: 1) Can My Baby Hear? 2) If your Baby is 
Referred for a Diagnostic Hearing Evaluation, and 3) Universal Newborn Hearing Screening: 
Frequently Asked Questions. These brochures were adapted from other resources on best 
practices. A video recording/interview highlighting the GEHDI project was on a local television 
show “KUAM and CARE FORCE” 2 parts Special Edition “ Can My Baby Hear?” with 
Fredalyn KUAM reporter, aired on ___________. K-57 Access Radio talk show on the GHEDI 
project, with Vicky Ritter and William Toves GEHDI staff. Articles published in the Mañagu 
Magazine for ----- and ------. 

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