Guam Early Hearing Detection & Intervention (Guam EHDI) Annual Report
Project Period: July 1, 2015-June 30, 2016 Tri-Fold

Cover: Mother holding baby smiling

Guam EHDI logo
University of Guam CEDDERS logo

Inside left page 

About Guam EHDI

The Guam EHDI Project was established in 2002 through a federal grant awarded to the University of Guam Center for Excellence in Developmental Disabilities Education, Research, & Service (Guam CEDDERS). The grant was awarded by the U.S. Health and Human Services (HHS), Health Resources and Services Administration (HRSA) to establish Guam’s Newborn Hearing Screening and Intervention Program. In 2003, Guam CEDDERS also applied for and received funding through a Cooperative Agreement with the U.S. HHS, Centers for Disease Control and Prevention (CDC) to establish an integrated data tracking & surveillance system to support the Guam EHDI Project.

Universal Newborn Hearing Screening and Intervention is mandated by Public Law 27-150,” the Universal Newborn Hearing Screening and Intervention Act,“ which was enacted in December 2004.Guam’s local legislation aligns with national goals and assures an upgraded standard of care for all babies born on Guam.

Early identification of hearing loss is important because:

• Hearing loss is the most frequent birth defect.*

• Undetected hearing loss has serious negative consequences

• There are dramatic benefits associated with early identification of hearing loss.


The goals of the current Guam EHDI Project are to assure that: 

• All babies born on Guam are screened for hearing loss by 1 month of age;

• Babies with hearing loss are diagnosed by 3 months of age;

• Quality early intervention services they need are initiated by 6 months of age (known as the “1-3-6 Plan”).


*Source: National Center on Hearing Assessment & Management (NCHAM), Utah State University.

Type of Hearing Loss Identified from November 2002-Present

Conductive*1 58

Sensorineural*2 24

Mixed*3 7

Total 89 

There were 89 infants identified with a hearing loss since the Guam EHDI project began in 2002. These infants were all identified and offered early intervention services through the Guam Department of Education, Guam Early Intervention System (DOE-GEIS).

*1. Conductive Hearing Loss-Type of hearing loss where sound is not conducted efficiently through the outer ear canal to the eardrum and can often be medically or surgically corrected.
*2. Sensorineural Hearing Loss- Type of hearing loss when there is damage to the inner ear or to the nerve pathways from the inner ear to the brain.
*3. Mixed Hearing Loss- Type of hearing loss that is a combination of conductive hearing loss and sensorineural hearing loss.

Note: Data is from 2 of 3 birthing sites: Guam Memorial Hospital Authority (GMHA) and Sagua Mañagu Birthing Center.
  
Inside Center page


Initial Screening*
*Initial Screening- Screening of infants for potential hearing loss prior to discharge from the birthing site.

Table header
 2012
 2013
 2014
 2015
 
Table data
Percent Screened
 99%
 99%
 99%
 99%
 
Benchmark
 98%
 98%
 98%
 99%
 
The Guam EHDI project has maintained a 99% initial hearing screening rate at Guam Memorial Hospital Authority (GMHA), and Sagua Mañagu Birthing Facility.
Guam Regional Medical City (GRMC) data is included in the 2015 screening rate.

Percent Lost to Follow-Up (LFU) Outpatient Rescreen*
*Outpatient rescreen- Follow-up rescreen of infants who did not pass their initial hearing screening.

Table header
 2012
 2013
 2014
 2015
 
Table data
Percent LFU for High Risk Rescreen
6%
7%
5%
2%

Benchmark
10%
10%
10%
10%

The Lost to Follow Up (LFU) rate for outpatient rescreens decreased to 6% in 2012, and increased to 7% in 2013. However, the rate decreased to 5% in 2014, and further decreased to 2% in 2015, exceeding the established Guam EHDI benchmark.

Inside right page 

High Risk Rescreen*
*High Risk Rescreen- Follow-up rescreen of infants who passed their initial hearing screening but have risk factors for potential late onset hearing loss

Table header
2012
2013
2014
2015

Table data
Percent LFU for High Risk Rescreen
33%
35%
17%
16%

Benchmark
20%
20%
20%
10%

The Lost to Follow Up (LFU) rate for High Risk Rescreens increased to 33% in 2012, and 35% in 2013. The rate decreased to 17% in 2014, exceeding the benchmark for that year. In 2015, the rate decreased to 16%, but was over 6% over the established 10% benchmark for the year.

Diagnostic Audiological Evaluation (DAE)*
*Infants who do not pass a follow-up rescreen, receive a DAE to determine whether or not a hearing loss is present and if so, the type and severity of the hearing loss.

Chart Table

Table header
Total Referred for DAE
Total with Normal Hearing
Total with Hearing Loss
Total with DAE by 3 months
Total DAE via Teleaudiology
Total Receiving Early Intervention (EI) Services
Total Receiving EI Services before 6 months
Total Pending DAE
Total Deceased
Total Relocating/Refusing Services
Total LFU

Table data
2012
40
13
4
13
11
12
10
3
1
10
0*1

2013
26
3
14
11
2
10
4
7
1
3
0*1

2014
50
10
8
13
0
5
4
6
1
7
5

2015
38
14
2
4
0
1
1
13
0
3
2


*1. In 2012 and 2013, there were no infants LFU for a Diagnostic Audiological Evaluation. This was due primarily to the implementation of the Teleaudiology project that began in November 2011 and ended in August 2013. This project involved the successful collaboration between Guam EHDI, The Childrens Hospital –Colorado, GEIS, and the DOE Audiology department.

Image: Otoacoustic Emissions (OAE) Hearing Screener

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Project Achievements
• Benchmarks were met for hearing screening performed on newborns at the civilian birthing sites before 1 month of age. 
• There were no infants loss to follow up (LFU) at the Early Intervention (EI) 
enrollment level.
• There was a reduction on the percentage of infants loss to follow-up who needed an outpatient rescreen or high risk rescreen.
• Successful strategies used to reduce loss to follow-up of infants needing rescreen included:
1. Offering alternate hearing screening appointment dates and sites;

2. Providing incentives for kept appointments;

3. Making reminder calls about appointment date/time;

4. Giving hearing screening outpatient appointments from the birthing sites before discharge.

• Public awareness on the importance of early detection of hearing loss through the screening and evaluation processes was greatly enhanced by the Project’s participation in numerous community outreach activities.
• Hearing screeners, physicians, parents and early intervention providers were surveyed to assess the Project’s strengths and needs for quality improvement purposes. The findings of these surveys will identify future training and technical assistance needs that will be addressed.
• Guam EHDI and the University of Hawaii, Telecommunications and Social Informatics (TASI) Research Program, continue to collaborate on the plan for interoperability between the Electronic Health Record (EHR) at the Department of Public Health and Social Services (DPHSS) and Guam ChildLink - EHDI. Timelines were developed and key staff were designated to specific roles to pilot the interoperability plan by June 30, 2016. Interoperability of data systems is a key milestone for achieving system sustainability.
• The Guam Regional Medical City, Guam’s newest birthing facility, joined the Guam EHDI Collaborative Partnership System.

Image: Father holding infant while an Audiologist performs an OAE Hearing Screening

Center back page

Guam Early Hearing Detection & Intervention Project (Guam EHDI) logo
University of Guam CEDDERS logo

For more information, visitwww.guamehdi.org
Guam EHDI
Phone: 735-2466 TTY: 734-6531 • Email: nenehearing@guamehdi.org 
Location: Dean Circle House 22-23, University of Guam 
Office Hours: Monday - Friday, 8am - 12 noon; 1pm - 5pm



The Guam EHDI Advisory Council meets quarterly to review and provide input on project policies, procedures, and activities. Members include, front row, seated, left to right: Glenda Leon Guerrero, Guam Regional Medical City (GRMC) Maternal Child Nurse Manager; Avelina “Bing” Opena, Guam Memorial Hospital Authority (GMHA) Head Nurse, Nursery; Joseph Flores; Joyce Flores, Guam EHDI Co-Chair; and Terry Naputi, Research Associate, Guam CEDDERS. Standing, left to right: Ruth Sabangan, GMHA Head Nurse, NICU; Brigette Flores-Lobo, United States Naval Hospital Educational & Developmental Intervention Services (USNH EDIS) Consultant; Maria Victoria Guiao, GMHA Head Nurse, OB Ward; LeeAnn QB Santos, Ph.D., USNH EDIS, Speech Language Pathologist; Terrie Fejarang, Guam EHDI Project Coordinator, Guam CEDDERS; Brittany Rosario, Sheena Dela Cruz, Brittney Babauta, Camille Glory, Nursing Staff, GRMC Nursery; Dawn Guerrero, Grant Assistant, Guam CEDDERS; Margaret Blaz, Ph.D., Follow Up Coordinator, Guam EHDI; Maggie Murphy-Bell, representing Margarita Gay, Maternal Child Health Administrator, Department of Public Health & Social Services, and Guam EHDI Advisory Council Chairperson; Heidi San Nicolas, Ph.D., Director, Guam CEDDERS & Principal Investigator, Guam EHDI; and Pat Mantanona, Guam Early Intervention System (GEIS) Guam, Division of Special Education, Department of Education, Program Coordinator.

Produced by the Guam Early Hearing Detection and Intervention (Guam EHDI) Project with 100% funding support from the U.S. Department of Health & Human Services, Health Resources and Services Administration, Grant No. 5UR3DD000784-05 and facilitated by the University of Guam Center for Excellence in Developmental Disabilities Education, Research, & Service (Guam CEDDERS). The University of Guam is an Equal Opportunity Provider and Employer.