NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

A. EXPERIENCE TO DATE: 
To meet the purpose of the Guam Early Hearing Detection and Intervention (Guam EHDI) 
project, the following describes impact and outcomes regarding loss to follow-up, data tracking 
and program monitoring/evaluation. Furthermore, the following report will describe the progress 
to date on specific goals and objectives for Year THREE of the grant and barriers encountered 
and strategies utilized to overcome the barriers. 

A.1 PROGRESS TO DATE: 
GOAL 1: Guam will continue to improve hearing screening rates from 95% to 100% for 
all infants born on Guam. Infants will be screened for hearing loss before 1 month of age, 
preferably before discharge. Guam will minimize missed and refer rates by increasing the 
infant return rate from the current 47% to 96% for those infants needing a 2nd screening. 
Objective 1.1 Guam will continue to carefully monitor the screening rate from month to month 
and work toward achieving the 95% to 100% screen rate. All infants born on Guam will 
received a hearing screening prior to discharge or 1 month of age as mandated in P.L. 27-150. 

Objective 1.1 Progress to Date: There are 3 birthing sites on Guam: the Guam Memorial 
Hospital Authority (GMHA), Sagua Mañagu Birthing Center, and the U.S. Naval Hospital 
(USNH) Guam. However, since May 2004, the USNH has not been reporting data on newborn 
hearing screening results to the Guam EHDI Project. The Guam EHDI Project continues to 
monitor on a monthly basis, the percentage of infants that received a hearing screening prior to 
discharge from GMHA and Sagua Mañagu. As indicated in Table 1, the percentage of infants 
screened prior to discharge from GMHA was at 99% and 94% for Sagua Mañagu between April 
to November 2007. There are varying reasons for the 2% or 40 babies not screened at GMHA 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

and Sagua Mañagu, including babies with a serious medical condition limiting the ability to 
conduct the hearing screening, babies that were medically evacuated off-island; and lastly 
GMHA staff failed to forward hard copy forms. To address the issue of GMHA staff failing to 
forward a hard copy to the Guam EHDI project, in July 2007, GMHA staff began piloting the 
new “Hearing Assessment Form” that will be uploaded into the Guam EHDI data tracking and 
surveillance system, also known as the Guam ChildLink system by May 2008. With the data 
provided electronically, Guam EHDI will have better accounting of all babies that were born and 
screened at GMHA. 

Table 1: Percentage of Newborn Screened from April – Nov. 2007 

Birthing Sites # Live Births % Screened % Not Screened 
GMHA 1734 99% (1716/1734 x 100) 18(1%) 
Sagua Mañagu 347 94% (325/347 x 100 ) 22 (6%) 
Total 2081 98% (2041/2081 x 100) 40 (2%) 

Guam EHDI provides monthly data reports to the head nurses at the birthing sites, of the 
percentage and numbers of infants screened prior to discharge, and the percentage and number of 
infants that failed initial screening prior to discharge. This data report is generated by Guam’s 
ChildLink data tracking and surveillance data system. In addition, individual screener data 
reports are generated on the percentage of pass and refer rates. The purpose for collecting this 
data of individual screeners is to determine which screeners may need additional training with 
the goal to reduce the refer rates and therefore alleviating the need for parents to bring their baby 
back for a re-screen. The Guam EHDI Screener provides monthly feedback to the head nurses 
and continues to implement a quarterly incentive program with the hearing screeners such as, 
“Hearing Screener of the Quarter” and incentive prizes for the lowest refer rate, most improved, 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

and most screened in each unit. Intensive training is offered for hearing screeners that may need 
additional practicum hours with stipends provided for those hearing screeners who attend. 
To address the issue of data not reported from USNH, in May 2007, the Guam EHDI staff met 
with Lt. Commander Captain Kellogg and his colleagues at USNH, to discuss the possibility of 
including newborn hearing screening results of USNH since hearing screening has been part of 
the standard of care for every infant born at that birthing site. Furthermore, providing this data 
will provide a more accurate and comprehensive picture of the percentage of the total number of 
infants that receive hearing screening and the percent of infants born on Guam. During that 
meeting, USNH agreed to begin sharing hearing screening data and a draft memorandum of 
agreement (MOA) was forwarded with specific data elements necessary. To this date, USNH is 
still reviewing the MOA. 

Objective 1.2 Continue to conduct intensive public awareness and community outreach 
presentations on the importance of early hearing detection, intervention, and the importance of 
follow up, so that each year of the grant cycle there are 6 specific evidence-based products that 
can be examined and the effect of the effort documented. 

Objective 1.2 Progress to Date: The Guam EHDI project continues to participate in various 
public awareness activities to promote the importance of newborn hearing screening. On an 
annual basis, comprehensive outreach activities are conducted with brochures, posters, and 
presentations held in the villages throughout the island. Packets of information are given to 
every public and private clinic, Mayors’ offices, high schools, and public and private agencies 
that parents frequent. The following products, focused on reducing loss to follow-up have been 
developed: 1) Hearing Risk Factors card for healthcare professionals, 2) What Do We Do Now? 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

brochure, 3) What Do We Do Next? brochure, 4) Guam Early Intervention System (GEIS) 6month 
mail out reminder post card, 5) Is Your Child At Risk for Hearing Loss poster, 6) Is Your 
Child At Risk for Hearing Loss? brochure, 7) Guam EHDI Directory of Services, and 8) Guam 
EHDI website www.guamehdi.com. These products were in dissemination in January 2008. 
Three brochures that were translated into Chamorro, Chuukese, and Tagalog, this included 1) 
Newborn Hearing Screening, 2) What do I do next? and 3) What do I Do Now? All others are in 
English. 

Objective 1.3 To improve the return rate for second screening, aggressive strategies will be 
used to ensure contact with parents in confirming appointments for re-screening prior to 
discharge from the birthing sites, and by training healthcare providers to follow up with families 
during one-week check-ups on the results of their baby’s hearing screening results and if 
appropriate, referral to PEDS for a follow-up hearing screening. 

Objective 1.3 Progress to Date: Of the infants screened prior to discharge at GMHA between 
April and November 2007, approximately 13% failed the initial screening prior to discharge and 
are referred to the Pediatric Evaluation and Developmental Services (PEDS) Center for a re-
screen before 1 month of age. This is an improvement of 3% from the last reporting period of 
16% fail initial screen. At Sagua Mañagu, 19% failed initial screen between April and 
November 2007, is an improvement from 38% reported last year. For those infants that fail 
initial screening, appointments are made with the parents to return to Sagua Mañagu for a re-
screen within two weeks after discharge. The high percentage of 16% fail initial screen is due to 
the turnover of nursing staff at Sagua Mañagu and the need for ongoing training for hearing 
screeners. Overall, 83% of infants return for a 2nd screen prior to 1 month of age and therefore 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

reducing the lost to follow-up at re-screen to 17% for this reporting period. This improvement 
from 28% reported last year was primarily due to re-screening held at the Sagua Mañagu and at 
GMHA. Appointments are made for re-screen prior to discharge at GMHA. As noted in Table 2, 
17% of infants are lost to follow-up from GMHA. 

Table 2: Number of Infants Lost to Follow-up at Re-screen 

Birth Site # Fail Initial 
Screen 
# Return for 
Re-screen 
# Lost to 
Follow-up 
% Lost to 
Follow-up 
GMHA 293 244 49 17% 

Although Guam EHDI demonstrated improvement, failure of parents to return for their infants’ 
re-screen continues to be a challenge. The Project will continue to implement the following 
strategies: 1) Appointments are made for re-screen prior to discharge; 2) Training of GMHA; and 

3) Public Awareness campaign (brochures and posters) staff to reinforce the importance of 
hearing screening follow-up; These strategies seem to be effective at this time and will continue 
to be monitored for its effectiveness. 
Objective 1.5 Results of the hearing screening will be provided to all parents and the infant’s 
primary care provider/medical home. 

Objective 1.5 Progress to Date: Prior to discharge from the birth sites, parents are given two 
copies of the hearing screening results with instructions to provide a copy to their child’s 
Primary Care Physician (PCP) or medical home at the first appointment after discharge. With 
feedback from the Guam EHDI Advisory Committee, the Guam EHDI Project implemented 
another step that would assist our efforts. For families with a known PCP, Guam EHDI staff will 
send a copy of the hearing screening results from the birthing sites and any re-screen results via a 
courier and delivered to the PCP’s Clinic. For infants that are referred for a full diagnostic 
evaluation (DAE), the audiologist provides families with two copies of the audiological 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

evaluation with instructions to provide a copy to their child’s PCP. For those infants with a 
known PCP, the audiological reports are mailed directly to their clinic. As noted earlier, there 
were several changes to the Guam EHDI procedures: 1) Families are now asked to sign the 
“Guam EHDI Re-screen Form” that provides consent for the Guam EHDI to conduct hearing re-
screen and authorization for “Release of Information” to the PCP; 2) if appropriate, to obtain 
information from Guam Public School System, Guam Early Intervention System (GEIS) 
regarding their child’s hearing evaluation reports and information on the services indicated in the 
child’s Individualized Family Service Plan (IFSP). Furthermore, GEIS recently amended their 
procedures to include a release of information for hearing screening and audiological evaluations 
from parents to the child’s PCP. The Guam EHDI project will closely monitor the change of 
procedures and will gather feedback from physicians if hearing screening results, re-screening, 
and audiological evaluations are provided to them. As a result of the MOA signed in April 2007, 
(See APPENDIX A) GEIS now has access and can update data through the Guam ChildLink 
data system for all infants suspected with having a hearing loss. GEIS can update any 
demographic information, view the last audiological evaluation and provide specific information 
in the child’s IFSP. The challenge still remains whether families actually provide the hearing 
screening results or DAE report to the PCP and currently Guam EHDI is developing possible 
ways to verify if PCPs actually receive a copy of the report from the family. 

Objective 1.6 Guam will continue to provide ongoing education/training for all service 
providers including screeners to both in-patient and out-patient nurses, and physicians. 

Objective 1.6 Progress to Date: The Guam EHDI staff continues to provide ongoing training 
for screeners at GMHA, Sagua Mañagu, GEIS, and the Department of Public Health & Social 

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April 1, 2008 – March 31, 2009 

Services (DPHSS) -Central Regional Public Health Center. Through technical assistance support 
from the National Center for Hearing Assessment and Management (NCHAM). In August 2007, 
Ms. Kim Aeillo,CCC-A, FAAA, a consultant from Colorado provided on-site training at GMHA 
and Sagua Mañagu to fourteen nurses on the usage of the GSI-70 and newborn screening and to 
increase their knowledge and skills on best practices and strategies to reduce refer rates from 
birthing sites. 

GOAL 2: All infants who screen positive will have a full diagnostic audiological evaluation 
before 3 months of age. Guam will reduce the time lag from referral to audiological 
diagnostic evaluation from an average of 8 months to an average of 1 to 3 months, by 
monitoring the time lag using the EHDI database for tracking and surveillance. 
Objective 2.1 Using the EHDI database continue to monitor the number of infants referred for a 
full diagnostic audiological evaluation on a monthly basis and carefully monitor the time 
between referral to DAE so that time lags can be decreased and stay within the first 3 months of 
life. 

Objective 2.1 Progress to Date: As indicated in Table 3, on the following page of the 10 
infants referred for diagnostic audiological evaluation (DAE), all (10 or 100%) were completed 
before 3 months of age. Audiological Associates, Guam EHDI’s Contractor for conducting 
DAEs is linked into the Guam ChildLink data system. AA now uploads the DAE directly into 
Guam ChildLink which supports the monitoring and tracking of the infants referred and the 
timeline for completion of the DAE. The timeliness of DAE has improved significantly since the 
beginning of this grant period from an average of 8 months to 1-3 months. 

Table 3: Referral for Diagnostic Audiological Evaluation (DAE) & IFSP 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

DOB Date of 
IS 
Date of 
DAE 
Date of IFSP Total Months from 
DOB to DAE 
Total Months from 
DOB to IFSP 
3/30/07 4/20/07 6/11/07 5/14/07 2 months 1 month 
5/6/07 5/7/07 Father refused services – says “baby can hear” 
5/8/07 5/11/07 6/20/07 6/12/07 
(pre-qualified) 
1 month 1 month 
5/27/07 5/28/07 7/16/07 No hearing loss 1 month N/A 
6/11/07 6/20/07 8/29/07 9/14/07 2 months 3 months 
6/26/07 6/27/07 9/6/07 No hearing loss 2 months N/A 
6/29/07 7/1/07 9/20/07 8/10/07 
(pre-qualified) 
2 months 1 month 
9/4/07 10/12/07 12/17/07 No hearing loss 3 months N/A 
10/10/07 10/12/07 1/7/08 Pending 2 months Pending 
10/22/07 10/23/07 12/11/07 1/3/08 1 month 2 months 

Objective 2.2 Network with professionals who conduct or are involved with any aspect of 
audiological diagnostic evaluations using various strategies which underscore the need for 
immediate follow-up on infants referred and the provision of copies of all evaluations are 
provided to parents. 
Objective 2.5 Develop a training plan to provide current information on pediatric audiological 
assessment procedures to assist professionals in keeping themselves updated. 

Objective 2.2 and 2.5 Progress to Date: On a quarterly basis, meetings are held with the 
audiologists to review the number of cases referred for DAE and to discuss other issues. In June 
2007, an agreement was made on a standardized DAE report format. The new format provides 
information on case history, diagnostic audiological exams, summary of results, and 
recommendations. Guam EHDI procedures were revised to ensure that the families are provided 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

two sets of reports, one for the family and the other is to be hand delivered to the child’s PCP via 
the parent. For families that have a known PCP, the Guam EHDI staff will send a copy of the 
DAE report to the PCP via courier. At this point we are uncertain how many physicians actually 
receive a copy of the results of the DAE from parents but strategies are considered. The most 
challenging barrier is the lack of a pediatric audiologist and the reluctance of GEIS audiologist to 
conduct DAE for infants. In August 2007 with support from the NCHAM, Ms. Kim Aiello, 
NCHAM Consultant, conducted onsite mentoring training and coaching for the two audiologists 
on Guam. The purpose of the 3 day focused training and technical assistance was to increase 
knowledge and skills on best practices in performing audiological evaluations and OAE on 
infants 6 months and older. 
Objective 2.3: Make parents of infants more aware of the critical importance of following 
through with full diagnostic assessment when their infants fail the 2nd screening. 

Objective 2.3 Progress to Date: As noted in Objective 1.2, public awareness information was 
developed and disseminated annually, beginning January 2008, reinforcing the importance of 
follow-up hearing assessments. When an infant fails the 2nd screen, parents are given a brochure 
entitled: “Newborn Hearing Screening on Guam – What DO I Do Next?” In addition, families 
are informed that a referral will be made to the GEIS. In August 2007, the Guam EHDI Parent 
to Parent support group facilitated an orientation for parents of children with hearing 
impairments. The purpose of this orientation was to share the supports available for families and 
linking families with other service providers. In August 2007, Ms. Kim Aiello conducted a 
parent night with fourteen parents in attendance. The purpose of the meeting was to increase 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

knowledge and skills about understanding audiological evaluations and the use of different 
modes of communication. 
Objective 2.4: Guam will identify linkages to assure that 98% of families whose infant is 
identified with a hearing impairment or deafness will have appropriate referral to medical, 
audiological, and early intervention services. 


Objective 2.4 Progress to Date: The Guam ChildLink data tracking and surveillance system is 
currently receiving information electronically from Sagua Mañagu, Audiological Associates, and 
GEIS. The hearing screening results of newborns from GMHA will be uploaded into the Guam 
ChildLink system by May 2008. Audiological Associates electronically uploads DAE reports 
into the Guam ChildLink server and copies are provided to the family with a copy to be 
forwarded to the child’s PCP. 

GOAL 3: All infants identified with a hearing loss will receive appropriate early 
intervention services before 6 months of age (medical, audiological, and early intervention). 
Guam will reduce the time lag from full audiological assessment to provision of early 
intervention services from an average of 10 months to an average of 2-6 months, by 
monitoring the time lag using the database for tracking and surveillance. 
Objective 3.1 Conduct monthly meetings with the early intervention staff to review infants 
referred to early intervention every year and to obtain the status of IFSP development. 

Objective 3.1 Progress to Date: The Guam EHDI staff has been meeting every month to 
review progress of infants referred for early intervention services. As noted on Table 3, of the 10 
infants referred during this reporting period, five IFSPs were completed by 3 months of age, 
three infants do not have hearing loss, one refused services, and one is pending. These monthly 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

collaboration meetings have been a key factor in careful monitoring of early intervention 
services for infants with hearing loss. In April 2007, GEIS signed a MOA to support Guam 
ChildLink by transmitting data through an electronic linkage for all infants with hearing loss or 
those at risk and receiving early intervention services. GEIS data clerk will electronically update 
demographic information, medical home or PCP, and early intervention services provided to the 
child and family. Guam EHDI will continue to meet with GEIS on a monthly basis to ensure the 
timeliness of IFSP completion by 6 months of age. Guam EHDI will continue to monitor and 
track all infants referred to GEIS through monthly meetings and through the Guam ChildLink 
data system. 

Objective 3.2 Yearly presentations will be held for primary physicians on appropriate medical 
services needed for infants with a hearing impairment. 
Objective 3.3 Guam will provide education and training opportunities to early intervention 
(Part C) and other support service staff that work with infants and toddlers on specific issues 
related to deafness and hearing impairment. 

Objective 3.2 and 3.3 Progress to Date: On August 15, 2007, Grand Rounds presentation for 
physicians, nurses, and service providers on “Beyond Universal Newborn Hearing Screening 
(UNHS), Where Are We Now?” was conducted by Ms. Kim Aeillo, CCC-A,FAAA, In addition, 
Ms. Aeillo conducted a presentation for early childhood providers to increase their knowledge 
and skills on strategies, resources and best practices in working with infants and toddlers with 
hearing concerns and their families, including red flags to watch out for, screening tools, and 
speech and language expectations. Nineteen participants from GEIS and three participants from 
USHN Educational, Developmental, Intervention Services (USHS-EDIS) were in attendance. 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

On August 17, 2007, seven early intervention staff attended a presentation by Kim Aeillo entitled 
"Colorado Hearing Resource (CO-Hear) Program - Service Delivery Model”. 
GOAL 4: All infants and children with late onset, progressive or acquired hearing loss will 
be identified at the earliest possible time. Guam will reduce the lost to follow-up for infants 
with high risk factors from failure to return rate of 82% to an average failure to return 
rate between 2 to 10% by monitoring the time lag using the EHDI database for tracking 
and surveillance. 
Objective 4.1 Conduct monthly meetings every year with professionals in early intervention to 
monitor high risk infants and high risk factors and to ensure that follow up hearing screening 
and data analysis is completed by 6 months of age. 

Objective 4.1 Progress to Date: The Guam EHDI staff has scheduled monthly meetings with 
GEIS to monitor the infants with high risk factors and to ensure that each infant receives a six-
month follow-up hearing screening. As noted in Table 4, the percentage of infants with high risk 
factors that have returned for a six-month hearing screening is at 48% for this reporting period. 
However, in tracking the progress of this objective, for the last 3 months there seems to be a 
reduction of the percentage of infants lost to follow up, at 42% in September, 22% in October 
and 26% in November. The primary reason for the improvement is due to the close monitoring 
of those infants at risk by using the Guam ChildLink data system. GEIS staff can view all 
infants with high risk factors and make contact with families. Having this report readily 
available at their office and regular monthly meetings has assisted in the monitoring of the 
infants referred. Furthermore, the data system continues to assist GEIS in their child find efforts 
in locating infants at risk since these same infants are eligible for GEIS services as documented 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

on Guam’s State Plan. Although there has been improvement, locating families continues to be a 
challenge for service providers. Guam has an extreme transient population from the Freely 
Associated States of Micronesia and the Republic of Palau. In June 2007, the Guam EHDI staff 
presented to the Mayor’s Council on the Guam EDHI project requesting their assistance if they 
know of families that may need our services. Brochures and posters were provided so they may 
be displayed throughout their villages. With a high percentage of families from the FSM State of 
Chuuk living on Guam, EHDI scheduled a meeting with a “Traditional Leader” from Chuuk 
residing on Guam to discuss strategies of how we could insure that families from Chuuk are 
aware of the Guam EHDI project and how they could access our services. Most important was 
that they understand the importance of hearing screening, evaluation, and intervention services. 
The Guam EHDI staff will continue to work closely with GEIS to monitor the timeliness of 
hearing screening for infants with possible late onset hearing loss. 

Table 4: Number of Percentage with High Risk Factors 

# High Risk # Return for 6-month 
screening 
# Loss to Follow-
up 
% Loss to Follow-
up 
174 90 84 48% 

GOAL 5: All infants with hearing loss will have a medical home and parent-to-parent 
support. 
Objective 5.1 Continue to promote the concept every year of a medical home to new physicians, 
medical support staff, and all professional who work with infants with identified hearing loss. 


Objective 5.1 Progress to Date: For progress on medical home training, refer to Objective 3.2. 
Objective 5.3 Provide workshops and training opportunities for families based on the data 
collected from the survey that was done at the Parent-to-Parent meeting on August 26, 2005. 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

Parents were asked to indicate areas where they feel they needed more information and 
assistance. The top three areas of need and how they are to addressed are as follows: 1) 
provide a Family-centered program to help families learn about language development skills in 
hearing impaired children, 2) provide information on hearing intervention options training for 
families, and 3) provide workshops on living with the child with a hearing loss in the home. 

Objective 5.3 Progress to Date: Parent training continues to address the issues identified in the 
results of the parent survey conducted in August 2006. On August 14, 2007, a presentation was 
conducted by Kim Aiello on “Understanding audiological evaluations and the use of different 
modes of communication”. Of the fourteen parent members in attendance, five were new parents 
to the Parent to Parent group of children with hearing loss. On August 25, 2007, Rebecca Santo 
Tomas, Attorney from Guam Legal Services, facilitated training on “Parent Rights”. Eleven 
parents were in attendance. On November 15, 2007, a presentation on Deaf Mentors. Fourteen 
parents were in attendance. Parents appreciated having a Deaf individual speak to them to 
discuss challenges, and what they can expect when their child leaves the school system. 

GOAL 6: Guam will have a complete EHDI Tracking and Surveillance System that will 
minimize loss to follow up. 
Objective 6.1 Work with the CDC funded cooperative agreement grant personnel and other 
relevant agencies such as Department of Public Health and Social Services, Guam Public 
School System, Division of Special Education, Guam Early Intervention System, and other 
professionals in identifying needed data fields to continue improving the tracking and 
surveillance effort. 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

Objective 6.1 Progress to Date In July 2007, a MOA with Sagua Mañagu was signed and 
continues to transmit hearing screening information of all infants born at their site. The MOA 
with GMHA was signed in July 2007 and in August 2007; GMHA began piloting the new 
“Hearing Assessment” data fields in their data system. Currently Guam EHDI’s expert 
consultant Mr. Quansheng Song works closely with Vince Quichocho, GHMA Director of 
Information Technology Services, on the conversion of the program into Guam ChildLink. Upon 
completion of the conversion, it is anticipated that GMHA will begin to upload data into Guam 
ChildLink. This will be Guam’s first integrated database system, electronically linking the 
Guam EHDI system to GMHA. As noted earlier, MOAs are in place and data is downloaded 
electronically from Sagua Mañagu, Audiological Associates, and GEIS. The newest linkage 
anticipated is with the Department of Public Health and Social Services, Maternal Child and 
Health, Central Public Health Clinic. The purpose is for the nurses to have access to information 
of infants that fail the initial screen. DPHSS-MCH will conduct hearing screening during the 
“well-baby check-ups” clinics and be able to access information on that baby. Training on the 
use of the GSI-70 was conducted in June and July 2007for the DPHSS MCH Central Community 
Center nurses and nurses aides. The Guam EHDI Hearing Screener continues to support 
DPHSS-MCH and monitor the hearing screening results of the nurse or nurse’s aide. 

Objective 6.2 Publish aggregate data findings from the Guam EHDI database in newsletters 
and other print media, public media, presentations to the advisory groups and public, and other 
available avenues for developing awareness on the importance of infant hearing screening and 
follow up. 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

Objective 6.2 Progress to Date On a quarterly basis, progresses made on the goals in the grant 
are provided to the Guam EHDI Advisory Committee. Members of the Advisory provide input 
and strategies for improving rates on the number of infants screened and those that are lost to 
follow-up. Furthermore, the Guam EHDI Project Coordinator reports on an annual basis, to the 
Part C -Guam Interagency Coordinating Council on the state of the Guam EHDI project. In 
addition, on a monthly basis, hearing screening information is provided to the nurse supervisors 
at GMHA and the General Manager of Sagua Mañagu to support the monitoring of hearing 
screening results. The Guam EHDI website will also be another venue that parents, consumers, 
or the community at large may review the data gathered by Guam EHDI. Dr. Velma Sablan is 
currently working on the “Guam ChildLink Update: The 2006 Report on the Status of Newborn 
Hearing Screening and Intervention on Guam”, a community publication expected to be 
completed by April 2008. This report will be disseminated to legislature, Governor, OB-GYN’s, 
Pediatrician, Early Childhood Teachers, and others who are key partners and do not make direct 
or regular contact with Guam EHDI. 

A.2 SIGNIFICANT CHANGES 
The following are changes that have occurred during the first grant year: 

. 
Key Personnel: Due to the passing of Kerina Oshiro, Guam EHDI Evaluator in June 2007, 
Dr. Velma Sablan will resume the responsibility as the Project Evaluator for the remainder of 
this grant period. Dr. Sablan was the Project Evaluator during the first round of EHDI 
funding. Dr. Sablan is very familiar with the project and is experienced in conducting 
program evaluation activities. Dr. Heidi San Nicolas will be replacing Dr. Sablan as 
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April 1, 2008 – March 31, 2009 

Principal Investigator for the EHDI project. Dr. San Nicolas was the Principal Investigator 
for the initial Guam EHDI grant. 

. 
Administrative or Organizational Structure: The Guam EHDI required personnel was 
changed with the deletion of the Guam EHDI Nurse Facilitator position, the change of the 
Principal Investigator to Dr. Heidi San Nicolas and Dr. Velma Sablan as the Project 
Evaluator (See APPENDIX B: Guam EHDI Administrative Structure and Key Partners) 
. 
Contacts or subcontracts: There are no changes to contracts or subcontracts. 
. 
Methodology for achieving goals and objectives: The Guam EHDI project will continue to 
monitor the implementation of the “Incentive Program” for hearing screeners at all birthing 
sites as a reinforcement and motivational strategy. In December 2007, the Guam EHDI 
Coordinator met with the nurse supervisors at GMHA to review strategies for improving the 
fail initial screening to less than 10%. It was agreed to continue the ‘Incentive Program’, and 
to assist GMHA in procuring materials to make a room in the nursery and the ward sound 
proof. Guam EHDI will continue to encourage hearing screeners to fine tune their hearing 
screening skills in order to reduce the number of infants that fail initial hearing screening 
prior to discharge, alleviating the need for parent to return for a re-screen as indicated in Goal 
1, Objective 1.1. With the sound proof room, outside noise will not be a factor in causing 
“False Fails”. Guam EHDI will continue the strategy in providing a second hearing 
screening at the child’s PCP clinic or medical home. The DPHSS Central Regional Public 
Health Center nurses and nurses’ aides were trained on infant hearing screening and the 
usage of the Otoacoustic Emmission (OAE) equipment. DPHSS Central Regional Public 
Health Center conducts re-screening for infants that come in for Well-Baby Checkups and 
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April 1, 2008 – March 31, 2009 

Preemie clinics. Babies that fail the second screen are referred for a DAE and to GEIS. 
Training for Northern and Southern Community Health Centers nurses and nurses’ aides is 
pending. Further discussion and agreement is needed on the procedures for hearing 
screening with the Public Health Administrator. It is anticipated that training will be 
conducted in Spring 2008. This following strategy will support Goal 2, objectives 2.1. 
Lastly, providing information of hearing results to the infant’s medical home or PCP will be 
monitored and tracked for its effectiveness. 

A.3 COLLABORATION AND COORDINATION: 
The Guam EHDI Project continues to collaborate with the DPHSS-MCH. Quarterly meetings 
are held with the Acting Director, Chief Public Health Officer, and MCH Supervisor on the 
status of project activities, challenges that have occurred, and anticipated linkages of the Guam 
ChildLink system. A MOA between the Guam EHDI Project and the DPHSS-MCH was signed 
in two years ago describing how Guam CEDDERS (administrator of the Guam EHDI Project) 
and DPHSS-MCH will provide support necessary to fully implement an integrated, sustained, 
and collaborative project to fully achieve the goals and objectives of the project. As a result of 
the signed MOA, it is anticipated that the promulgation of the rules and regulations as indicated 
in Public Law 27-150 will be completed after it is reviewed by the Adjudication Process. One of 
the strengths of the Guam EHDI project is the active involvement of the Guam EHDI Advisory 
Committee, which is a subcommittee of the Guam Interagency Coordinating Council. The 
Advisory Committee meets on a quarterly basis to review and provide feedback on the progress 
made on the goals of the project. Composition of the Guam EHDI Advisory Committee consists 
of 7 parents or 35% parents and 13 or 65% service providers to GMHA, Sagua Mañagu, GEIS, 

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April 1, 2008 – March 31, 2009 

Parent Advocacy Group, and the Guam EHDI Champion. As part of the Center for Disease 
Control and Prevention (CDC-EHDI) Cooperative Agreement received by Guam CEDDERS, a 
MOA was signed to purchase technical assistance through a data consultant from the University 
of Maine, Mr. Quansheng Song. Mr. Song has been to Guam once this grant year to support the 
GMHA linkage to Guam ChildLink. 

A.4 SIGNIFICANT FINDINGS 
A significant impact of the Guam EHDI Project has been the development and implementation 
of the Guam ChildLink system, which has made data readily accessible. The accessibility of 
data has enabled Guam EHDI staff to closely monitor the rates of hearing screening, timeliness 
of DAE, and implementation of IFSPs; resulting in the reduction of the number of infants lost to 
follow-up. 

A.5 DATA REQUIREMENT 
The Guam EHDI Project reports, on a quarterly basis, to the Guam EHDI Advisory Committee 
progress on the goals and objectives of the grant. A progress report is disseminated to committee 
members for their review. Members are asked to provide suggestions or recommendations to the 
report. Hearing screening data for Guam are also reported to the CDC EHDI. The Guam EHDI 
staff obtains live birth rate data from the DPHSS Office of Vital Statistics and retrieves data from 
the Guam ChildLink system, which are included in the progress reports. Data on the number of 
infants screened, infants referred for DAE and GEIS (Refer to Tables 1 to 4) are also reported in 
the Guam Part C Annual Performance Report that is sent to the U.S. Department of Education, 
Office of Special Education Programs. The Guam EHDI also provides data to the National 
Information and Reporting System under the Association of University Centers on Disabilities 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

on the number of infants screened and activities that occurred in the project. Furthermore, project 
information is reported, on a quarterly basis, in the Guam CEDDERS – “I Tellai: The Bridge” 
quarterly newsletter. A data link is included on the Guam EHDI website at www.guamehdi.com 
which will report the following data: 1) Percent screened, 2) Percent lost to follow-up, 3) 
Number referred for DAE, 4) Number identified with hearing loss. This data link is updated 
quarterly basis. The Guam EHDI project is working closely with GEIS to develop procedures 
for linking families including families of infants identified with hearing loss to their PCP or 
medical home and to the Guam EHDI Parent to Parent Support Group. 

A.6 RESPONSE TO CONDITIONS/RECOMMENDATION FROM MCHB: 
As indicated in the Notice of Grant Award, there were no conditions noted. However, there was 
a reporting requirement due within 120 days: all performance measures, financial and 
demographic data forms were completed and uploaded into the electronic handbook (EHB). 

A.6 PLANS FOR UPCOMING BUDGET YEAR 
Plans for the budget year 2008 – 2009 will remain as stated in the Grant application. Personnel 
will include the following key personnel funded by the grant: Guam EHDI Coordinator at .19 
FTE; Hearing Screener at 1.0FTE; Research Associate at .10FTE; and Project Evaluator at .5 
FTE. The funds initially allocated for the Guam EHDI Nurse Facilitator in the amount of $2,487 
will be transferred to the supply category to support the nurse “Incentive Program” with the 
hearing screening and to purchase materials needed to reduce outside noise. The following are 
unmet needs, barriers, successful strategies and resources: 1) Lack of Pediatric Audiologist on 
Guam – currently there is only ONE audiologist on Guam that is available to assess infants for 
possible hearing loss. Parents who have a concern regarding the results of the assessment are 

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NARRATIVE PROGRESS REPORT 
April 1, 2008 – March 31, 2009 

challenged with seeking a second opinion off-island; Guam EHDI will be working with Higher 
Education Institutions to encourage local students to receive training off-island in pediatric 
audiology. 2) Implementing a “Medical Home” concept the “island way” continues to be a 
struggle in getting “buy-in” from physicians; Guam EHDI is working closely with a 
Developmental Pediatrician to conduct mini training sessions in February 2008 to promote the 
importance of medical home and how this concept will look for a child with disabilities on 
Guam. 3). Lack of data sharing with USNH. Since 2004, USHN continues to implement 
universal newborn hearing screening as part of standard of care and follow up services are 
provided through USNH EDIS. However, this data is not reflected in Guam’s EHDI data report 
to HRSA and therefore the percentage of infants screened prior to discharge is not a true 
reflection on Guam. Guam EHDI Project Coordinator continues to work with the USHS EDIS 
personnel to communicate with, to their colleagues, the importance of data sharing. In addition, 
Guam EHDI will request technical assistance from HRSA to determine whether there are 
national guidelines and or policies for the transfer of data from Military Health Facilities to State 
and public entities. 4). Multicultural diversity and transient populations. Guam EHDI will 
continue to update demographic information and ask families for contact information of 
neighbors or relatives as a means of locating families to return for a hearing screening or DAE. 
Furthermore, Guam ChildLink allows for DPHSS-MCH Regional Community Health Centers, 
GEIS, and Audiological Associates to update demographics when making contact with families. 

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