III.   PROJECT NARRATIVE

A. Purpose of Project

Good hearing in children is essential to normal development.  All too, often, identification of a child’s hearing impairment is delayed. If undetected and untreated, hearing loss can lead to delayed speech and language development, social and emotional problems, and academic failure.  Routine medical care should include the hearing screening that could identify those children with hearing loss.  By detecting hearing loss during the newborn period, families can be informed of their child’s hearing status and effective treatment can be initiated immediately.

In South Dakota, Governor William J. Janklow will be starting a major new initiative to ensure that the systems are in place to meet the needs of South Dakota’s youngest citizens.  Bright Start will help ensure that all babies born in South Dakota have a good start in life through the provision and promotion of primary and preventive services such as immunizations, home visiting for at-risk families, expansion of the Children’s Health Insurance Program (CHIP), and other activities.  An important part of Bright Start will be to assure that all infants born in South Dakota receive a hearing screening.

While there is currently not a statewide newborn hearing screening mandate in place in South Dakota, several hospitals voluntarily provide hearing screening for newborns.  However, many hospitals in South Dakota do not provide screening for infants born in their facility.  To encourage more facilities to screen infants for hearing impairment, a joint letter from Governor Janklow and the Secretary of Health was sent to all hospitals in the state (see Appendix A).  Hospitals were asked to respond back to the Department of Health (DOH) on the status of newborn hearing screening in their facility and their willingness to participate in the program either by purchasing the necessary equipment or by working with an established program or audiologist to provide the screening.  Preliminary response to the letter has been positive.  Governor Janklow also reemphasized the importance of newborn hearing screening and his intention of assuring every infant born in South Dakota receives a hearing screening during his recent State of the State address which was given to a joint session of the South Dakota Legislature on January 11, 2000.

The DOH is proposing to utilize grant funds to establish a newborn hearing screening program in the state that will assure that every baby born in South Dakota is screened for hearing loss by the age of three months and that children who are identified as having a potential hearing impairment receive appropriate follow-up testing, treatment and intervention.  The first year of the grant will be primarily a planning year to develop the state infrastructure to provide technical assistance and program support to providers, hospitals, parents, and others to facilitate hearing screening.  The DOH intends to work with hospitals and physicians over the next year to assist them in accessing resources to purchase equipment or to network with other hospitals and/or audiologists to establish outreach programs for infants born in their facility.

The second, third and fourth years will focus on refining the infrastructure with the ultimate goal of full implementation of a newborn hearing screening program by the end of the four year project period.

B. Organizational Experience and Capacity

The South Dakota Department of Health is an executive-level department with the Secretary of Health appointed by, and reporting to, the Governor.  The department is organized into three divisions (see organizational charts in Appendix B):

• The Division of Health and Medical Services emphasizes development of health care service systems for families, children/adolescents, mothers, and children with special health care needs (CSHCN);
• The Division of Administration provides centralized support to DOH programs including financial management, computer systems, communications, health planning, legislative coordination, grant writing, and research.  The Office Data, Statistics and Vital Records located in this division maintains the vital records systems for the state as well as provides technical assistance for the development, implementation and evaluation of data collection activities; and
• The Division of Health Systems Development and Regulation administers regulatory programs related to health protection, health care facilities and emergency medical services.

The DOH is the state agency responsible for the administration of the Maternal and Child Health (MCH) block grant in South Dakota.  Oversight of the MCH block grant is provided through the Office of Family Health (OFH) located in the Division of Health and Medical Services.  OFH directs care coordination services for children with chronic illness, disabling conditions and other special health care needs through the state’s Children’s Special Health Services (CSHS) program.  The CSHS program also coordinates diagnostic and consultive outreach pediatric specialty clinics and provides financial assistance for specified conditions and procedures on a cost share basis.  In addition, OFH provides program direction and technical assistance for primary and preventive care for women and infants including risk assessment and case management of pregnant women, genetic counseling, perinatal education, prenatal and post-partum home visits, and newborn screening for metabolic disorders.  The South Dakota Newborn Hearing Screening Program will be located in the Office of Family Health.

The MCH block grant has a core performance measure that addresses the percentage of newborns who have been screened for hearing impairment before hospital discharge.  To address this performance measure, the MCH program has surveyed hospitals in the state to determine the prevalence of newborn hearing screening.  Through the voluntary participation of hospitals, 42% of infants were screened in 1996, 47.4% were screened in 1997 and 51% were screened in 1998.  Based on the results of this survey and preliminary 1999 birth data, the DOH projects that the number of infants screened for hearing impairment will be 62% in 1999.

C. Administration and Organization

The Newborn Hearing Screening Project Coordinator also serves as the CSHS director for the state.  The service delivery system for CSHCN is a regional system with 12.1 FTE (including nursing, dietitians and social work) staff providing services at offices in Pierre, Sioux Falls, Aberdeen, and Rapid City.  Services are provided in a community-based manner that enables families to receive appropriate consultation and care planning as close to their child’s home as possible.  Pediatric specialists, dietitians, nurses, and social workers function as a multi-disciplinary team with families to assist them in meeting the needs of CSHCN.  The CSHS service delivery system represents a unique private-public partnerships between the DOH, the USD School of Medicine and numerous hospitals and physicians across the state.

Ongoing activities for CSHS staff include coordination of care for CSHCN and their families.  An important activity to promote optimum coordination of care is the networking that occurs at the local, regional and state level between CSHS staff, providers and other pertinent entities that serve CSHCN and their families.  As part of the Newborn Hearing Screening Program, CSHS staff will work with hospitals with established newborn hearing screening programs and their referral systems to assure appropriate follow-up and care for identified infants.  In addition, CSHS will provide follow-up on those infants that are not part of an established referral system to coordinate further evaluation and coordination of appropriate services with the infant’s medical home, family support, early intervention, and other services as needed.  While newborn hearing impairment is not currently a coverable condition under CSHS in South Dakota, CSHS staff have well established relationships with physicians, hospitals, single points of contact for Birth to 3, and family support to facilitate follow-up services for infants in the state.  These relationships and networks can be easily expanded to include audiologists, speech pathologists and other professionals providing services to children identified with hearing impairment.

The CSHS director also serves on the State Interagency Coordinating Council for Birth to 3.  The purpose of the council is to ensure collaboration in the maintenance and implementation of a statewide, comprehensive, coordinated, multi-disciplinary, and interagency service delivery system for children eligible under Part C of the Individuals with Disabilities Education Act (IDEA).  The system is designed to ensure the availability and accessibility of early intervention services for all eligible infants and toddlers and their families.  The DOH participates in an interagency agreement with the Departments of Education and Cultural Affairs (DECA), Human Services (DHS) and Social Services (DSS) that specifies the roles and responsibilities of these agencies related to the specific services required and provides guidance for their implementation.  A copy of the most recent Interagency Agreement is provided in Appendix C (this agreement is in the process of being updated).

The DOH has a long-standing collaborative relationship with the South Dakota University Affiliated Programs (UAP).  As a Leadership Education in Neurodevelopmental and Related Disorders (LEND) grantee, the UAP is serving a vital role as the only training program in the state that provides specialty educational opportunities to graduate students in the fields of medicine, nursing, social work, nutrition, speech pathology, audiology, pediatric dentistry, psychology, occupational therapy, physical therapy, and health administration.  LEND graduates will form the core workforce of professionals in the state who are skilled and knowledgeable leaders in all aspects of care regarding neurodevelopmental disabilities in children.  Further, LEND graduates are specially trained to meet the unique needs of residents of South Dakota.  Both the Title V MCH director and CSHS director serve on the LEND advisory committee.  In addition to LEND, MCH and UAP coordinate on a number of other training and interagency projects.  A copy of the Interagency Agreement with LEND is provided in Appendix D.

D. Available Resources

As was mentioned earlier, the Newborn Hearing Screening Program will be located within the DOH Office of Family Health.  In addition to the other MCH staff located within the OFH, the Project Coordinator will have the following staff available to assist with project implementation:

• CSHS staff will provide networking, coordination and follow-up services.
• Sarah Patrick, MPH, Ph.D., State Epidemiologist, will oversee development and ongoing maintenance of data systems as well as provide technical assistance on the monitoring and evaluation functions of the Newborn Hearing Screening Program.
• Kathi Mueller, Manager, Office of Data, Statistics and Vital Records, will provide technical assistance for the development, implementation and evaluation of surveillance and evaluation activities for the Newborn Hearing Screening Program.
• Linda Zeller, Finance Officer, will provide technical assistance on all financial matters related to the Newborn Hearing Screening Program including budget development and approval, contract approval, purchasing, and financial reporting.
• Betty Harter, Secretary, will provide clerical support for the Newborn Hearing Screening Program.

In addition, nine hospitals in the state provided some level of newborn hearing screening for infants born in their facility in 1998.  The Project Coordinator will utilize the expertise of these established programs in the areas of technical assistance, staff training, protocols/guidelines, and referral systems in the development of the state’s infrastructure.

E. Identification of Target Population and Service Availability

The target population for the Newborn Hearing Screening Program is all infants born in South Dakota.  There are several barriers to meeting the needs of the target population.

South Dakota is one of the least densely populated states in the nation with 696,004 people living within its 75,955 square miles – 9.2 people per square mile.  Over half of the state’s 66 counties are classified as frontier (population density at or below six persons per square mile), 29 are considered rural (population density above 6 persons per square mile but no population centers of 50,000 or more) and three are classified as urban (having a population center of 50,000 or more).  Of the state’s total population, 91.2% are White, 7.3% are Native American and 1.5% are classified as Other.

Access to health professionals who provide primary care is limited in the state.  According to a survey conducted by the DOH Office of Rural Health, there were 1,153 active physicians licensed in South Dakota in 1997.  Of those, 55.5 percent practiced in an urban location (either Minnehaha or Pennington county), 32.5 percent practiced in a large rural community (the next 11 most populous counties), and 12.0 percent practiced in a small rural community (all other counties).  Of those, 525 are considered primary care physicians for a population to primary care physician ratio of 1,326 to 1 compared to the U.S. ratio of 1,027 to 1.  There are also about 300 FTE primary care physician assistants, nurse practitioners and nurse midwives located in the state.  Access to audiologists is also limited with approximately 39 audiologists licensed in South Dakota in 1999.

There are 41 hospitals in the state that performed deliveries in 1998.  Of these, six hospitals provided hearing screening for all infants born in their facility.  An additional three hospitals provided screening for high risk infants or upon physician referral.  The small number of deliveries at many of the hospitals does not justify the purchase of screening equipment.  The Project Coordinator will work with those facilities to help them network with hospitals who have an established program or with an audiologist to provide the necessary screening and follow-up.  One of the major challenges that the Newborn Hearing Screening program will have to address is tracking infants that are referred out of the birth facility for medical reasons.  In South Dakota, there are three Level III hospitals located at opposite ends of the state – two in Sioux Falls and one in Rapid City.  Many infants are referred out of state for further medical treatment.  The Project Coordinator will work closely with hospitals and providers to assure that all infants born in the state receive the required screening, regardless of where they are referred for follow-up medical treatment.

F. Needs Assessment

For the past two years, the department’s MCH program has conducted a survey of all hospitals doing deliveries to determine whether the facility was providing hearing screening for infant born in their facility.  While this survey will be continued, it will be modified to collect the necessary information for the Newborn Hearing Screening Program (i.e., number of babies born in the facility, percentage successfully screened, percentage referred, percentage rescreened and/or diagnosed, and number identified with hearing loss).  Through their networks, CSHS staff will also be able to assist in determining unmet needs and barriers to newborn hearing screening services and follow-up.

Through the work already conducted, the DOH has identified those hospitals in the state that are currently providing some level of newborn hearing screening for infants born in their hospital (see Appendix E).  During the first year of the project, the project coordinator will work with delivery hospitals to further determine their estimated state of readiness to implement newborn hearing screening including availability of equipment, funding concerns, availability of an audiologist on staff, estimated stage of behavior change (i.e., precontemplation, contemplation, ready for action, action, maintenance), etc.  Through these qualitative and quantitative processes, the DOH has established the statewide planning goals for this newborn hearing screening grant.  The DOH will work with facilities to more from one state of institutional behavior change to the next until the ultimate goal of voluntary universal newborn hearing screening is accomplished statewide by 2004.  The project coordinator will develop and use stage-specific facilitation techniques/resources to work with delivery hospitals on this process.

G. Collaboration and Coordination

South Dakota’s public health system includes the DOH, other state agencies, community health centers, Indian Health Service (IHS), tribal health representatives, and other public/private organizations.  The DOH has developed numerous collaborative relationships with the entities in an effort to meet the health care needs of South Dakotans.

As was mentioned earlier, the DOH participates in an interagency agreement for the provision of services under Part C of IDEA.  Under this agreement, the DOH provides the following services:

• Child health conferences – nursing physical assessments, developmental screening (RPDQ & Denver II), age appropriate vision/hearing screening, and patient education;
• Care coordination for CSHCN;
• Age appropriate immunizations;
• Newborn assessments (nursing physical assessment; parent education);
• School health services as designated in contractual agreements with school districts;
• Medical evaluations, diagnosis and treatment by pediatric specialty physicians for CSHCN;
• Care coordination for CSHCN;
• Nutrition education and counseling for CSHCN; and
• Supplemental food program for women, infants and children (WIC) (supplemental foods, nutrition education, referrals to health care professionals).

As was also mentioned earlier, the DOH has a long-standing collaborative relationship with the UAP which serves a vital role as the only training program in the state that provides specialty training for health-related disciplines.

The DOH currently collaborates informally and through a formal contract with the South Dakota Parent Connection.  Parent Connection serves as the Parent Training and Information Center for the state and as such has provided parent workshops and trainings throughout the state as well as trainings for CSHS staff.

OFH will enhance the current relationship with audiologists providing services in the state.  The expertise of the South Dakota Association of Audiologists and individual audiologists will be a key factor in the development of a statewide newborn hearing screening and follow-up program.

The Newborn Hearing Screening Program will enhance the existing working relationships the DOH has with hospitals and health care systems in the state.  These working relationships will promote expansion of newborn hearing screening to additional hospitals, outreach to smaller hospitals performing deliveries, referral for additional evaluation, coordination of appropriate services, and tracking of infants with hearing impairment.

The DOH and DSS have an interagency agreement to establish and assure referral mechanisms between agencies (see Appendix F).  The intent of this agreement is to maximize utilization of services and assure that the services provided under Title XIX and Title V are consistent with the needs of the recipients and that the objectives and requirements of the two programs are met.  The agreement establishes procedures for early identification and referral of individuals under age 21 in need of services such as early and periodic screening, diagnosis and treatment (EPSDT), family planning, case management, and WIC.  Representatives from both agencies meet regularly to discuss various issues including case management of high risk pregnant women, referral mechanisms, outreach for Medicaid, and CHIP.

In addition, the DOH collaborates with DHS on the state’s Respite Care Program.  The program has an advisory workgroup with representation from various state programs serving families who have children with special needs including special education, child protection, developmental disabilities, mental health, and CSHS.  The program is jointly funded with state general funds, MCH block grant funds and DSS federal grant funds.  The Respite Care Program offers services statewide.  MCH block grant funds are expended to provide services for children on the respite care program diagnosed with chronic medical conditions.  CSHS staff assist families with referral to the Respite Care Program.

IHS delivers services to the Native American population on the state’s nine reservations.  There are five IHS hospitals and six IHS health centers in the state.  On many of the reservations, tribally-appointed community health representatives also provide services.  DOH staff have ongoing communications with the Northern Plains Healthy Start Project.  Local DOH staff participate on local consortia and central office staff have attended statewide consortia meetings to share information, problem solve, and network.  Healthy Start also provides representation on a variety of DOH perinatal workgroups.

The DOH maintains a memorandum of agreement (MOA) with the State Primary Care Association to enhance the delivery of comprehensive primary and preventive health care for the residents of the state.  In addition, there are eight federally qualified community health centers (CHCs) with 17 sites statewide that provide primary health care services to underserved populations in the state regardless of their ability to pay.  The DOH meets regularly with CHC representatives to explore ways to increase collaboration and coordination of health care services.

Finally, the DOH participates on numerous workgroups, task forces and advisory committees including, but not limited to:  Respite Care, Interagency Coordinating Council for Birth to Three, Governor’s Planning Council on Developmental Disabilities, and UAP committees.

H. Goals and Objectives

Goal:  By 2004, South Dakota will have a fully implemented, sustainable program of newborn hearing screening, audiologic diagnosis and enrollment in early intervention.

Objective 1.  By March 30, 2001, develop state infrastructure necessary to provide technical assistance and program support to physicians, hospitals, parents, and others to facilitate newborn infant hearing screening.

1.1   By April 1, 2000, identify DOH staff to coordinate the newborn hearing screening program for the state.

1.2.   By May 1, 2000 and ongoing, provide technical assistance to facilities not currently providing hearing screening to assist in establishing a screening program within their facility (i.e., equipment, protocols, training, referral mechanisms, etc.).

1.3.   By September 1, 2000, establish the Newborn Hearing Screening Advisory Workgroup.

1.4.   By September 1, 2000 and ongoing, develop draft recommended screening protocols and guidelines for newborn hearing screening for use in hospitals.

1.5.   By September 1, 2000 and ongoing, develop and pilot reporting mechanisms to collect information from hospitals regarding number of babies born at the hospital, percentage of babies successfully screened, percentage of babies referred, percentage of babies rescreened and/or diagnosed, number of babies identified with hearing loss, and quality assurance indicators.

1.6.   By September 1, 2000 and ongoing, develop procedures for linking newborn screening program with the infant’s medical home, family support and early intervention (Part C).

1.7.   By November 1, 2000 and ongoing, develop plan for professional education and information regarding newborn hearing screening diagnosis and early intervention.

1.8.   By November 1, 2000 and ongoing, develop plan for parent/public education and information regarding newborn hearing screening, diagnosis and early intervention.

Objective 2.  By March 30, 2002, 75% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary.

2.1.   By April 1, 2001 and ongoing, convene quarterly meetings of the Newborn Hearing Screening Workgroup.

2.2.   By April 1, 2001 and ongoing, continue to link infants identified with hearing impairment with the infant’s medical home, family support and early intervention.

2.3.   By April 1, 2001 and ongoing, continue with professional and parent/ public education and information regarding newborn hearing screening, diagnosis and early intervention.

2.4.   By April 1, 2001 and ongoing, collect, analyze and report on the status of newborn hearing screening in South Dakota and the extent to which the program is linked to the infant’s medical home, family support and early intervention.

2.5   By October 1, 2001, finalize and refine reporting mechanism.

2.6.   By January 1, 2002, finalize and disseminate recommended screening protocols/guidelines.

2.7.   By February 1, 2002 and ongoing, provide training to hospitals on the recommended newborn hearing screening protocols and guidelines.

Objective 3.  By March 30, 2003, 90% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary.

3.1   By April 1, 2002 and ongoing, maintain and sustain established program.

Objective 4.  By March 30, 2004 and ongoing, maintain program that will assure 90% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary.

4.1   By April 1, 2003 and ongoing, maintain and sustain established program.

I. Required Resources

Grant funds are requested to support 0.5 FTE and benefits for the project coordinator to be located within the Office of Family Health.  The project coordinator will serve as the grant coordinator and provide program and staff guidance to meet stated program objectives.  Grant funds are also requested to support in-state travel for the project coordinator to meet with hospital staff throughout the state regarding the newborn hearing screening program as well as the Newborn Hearing Screening Workgroup members to attend quarterly meetings of the workgroup.  Out-of-state travel is requested to allow the Project Coordinator and MCH director to travel to Washington, D.C. to meet with MCHB program staff on an annual basis.  Funds will also support an audiology consultant and medical consultant to assist the project coordinator in developing and implementing the program.  Finally grant funds are requested to provide administrative and office support (i.e., computer, postage, telephone, printing, etc.) for the Newborn Hearing Screening Program.  A full budget justification for the Newborn Hearing Screening Program is provided on page vi.

J. Project Methodology

PROJECT ACTIVITIES TIME ALLOCATION TABLE

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2000 to March 30, 2001 State:  South Dakota

Objectives and Approaches	Start Date	Completion Date	Tracking/Evaluation Methods
Objective 1.  By March 30, 2001, develop state infrastructure necessary to provide technical assistance and program support to physicians, hospitals, parents, and others to facilitate newborn infant hearing screening. 1.1   1.1.  By April 1, 2000, identify DOH staff to coordinate the newborn hearing screening program for the state.	04/10/2000	04/01/2000	-   Name project coordinator. -   Update position description to include newborn hearing program duties.
1.2.  By May 1, 2000 and ongoing, provide technical assistance to facilities not currently providing hearing screening to assist in establishing a screening program within their facility (i.e., equipment, protocols, training, referral mechanisms, etc.).	05/01/2000	Ongoing	-  Establish priority list of facilities. -  Conduct needs assessment within prioritized facilities. -  Document presentations, telephone consults and other assistance provided.
1.3.  By September 1, 2000, establish the Newborn Hearing Screening Advisory Workgroup. · Identify potential workgroup members which may include representatives from the following: -  Audiologists -  Speech pathologists -  UAP -  Part C/Birth to 3 -  Pediatrician -  Family Physician -  IHS -  Parent/Parent Connection -  SD School for the Deaf -  Hospital representative (urban/rural) -  Health systems representative -  Newborn nursery/OB nursing representative · Appoint workgroup members. · Schedule first meeting of the workgroup.	06/01/2000 07/01/2000 09/01/2000	09/01/2000 07/01/2000 Ongoing	-  Create potential group membership list by facility, educational background, group being represented, etc. -  DOH Secretary to send letter of invitation to members. -  Work with DOH Public Information Officer to disseminate information on workgroup creation. -  Log media coverage of workgroup (continue throughout project). -  Create final list of workgroup members. -  Create calendar of quarterly workgroup meetings and collect minutes for them. -  At first meeting, divide workgroup into functioning subgroups for protocol development, data collection, provider outreach, and parent education.
1.4.  By September 1, 2000 and ongoing, develop draft recommended screening protocols and guidelines for newborn hearing screening for use in hospitals. · Collect screening protocols and guidelines from other states. · Appoint subgroup of the Newborn Hearing Workgroup to assist in the development of screening protocols and guidelines for use in South Dakota. · Develop draft protocols/guidelines for review by the workgroup. · Revise draft based on input from workgroup. · Distribute draft protocols/guidelines to providers and hospitals for review.	09/01/2000 06/01/2000 09/01/2000 12/01/2000 07/01/2001 08/01/2001	Ongoing 09/01/2000 Ongoing 06/30/2001 07/01/2001 08/01/2001	-  Collect newborn hearing screening protocols from SD hospitals already providing screening. -  Collect newborn hearing screening protocols from other states. -  Review and discuss existing protocols, editing and revising to create protocols for distribution by the workgroup to SD hospitals. -  Place draft protocol on DOH web-site for public comment. -  Distribute draft protocol to health care providers and hospitals for review.
1.5.  By September 1, 2000 and ongoing, develop and pilot reporting mechanisms to collect information from hospitals regarding number of babies born at the hospital, percentage of babies successfully screened, percentage of babies referred, percentage of babies rescreened and/or diagnosed, number of babies identified with hearing loss, and quality assurance indicators. · Collect data collection tools from other states. · Appoint subgroup of the Newborn Hearing Workgroup to assist in the development of reporting mechanism for use in South Dakota. · Pilot proposed data collection tool in 5 hospitals. · Refine data collection tool as necessary. · Provide training on the use of the data collection tool for hospitals. · Provide data collection tool to all hospitals. · Meet with the Office of Data, Statistics and Vital Records to explore birth certificate system to collect newborn hearing screening data.	06/01/2000 09/01/2000 01/01/2001 07/01/2001 09/01/2001 10/01/2001 01/01/2001	09/01/2000 Ongoing 07/01/2001 08/01/2001 09/30/2001 10/31/2001 Ongoing	-  Collect data tools from other states. -  Data workgroup will explore reporting mechanisms, define key variables, and determine collection process (including analysis and dissemination). -  Pilot draft data collection tool in 5 hospitals. -  Edit tool, as warranted by pilot results. -  Disseminate data collection tool to all hospitals. -  Schedule and hold regional data collection training sessions. - Create minutes of electronic birth certificate meetings.
1.6.  By September 1, 2000 and ongoing, develop procedures for linking newborn screening program with the infant’s medical home, family support and early intervention (Part C).	09/01/2000	Ongoing	-  In eligible areas of the state, create a mechanism to link newborn hearing screening program to home visitation program.
1.7.  By November 1, 2000 and ongoing, develop plan for professional education and information regarding newborn hearing screening diagnosis and early intervention. · Letter to hospitals/providers · RDTN/distance learning educational opportunities. · Professional association conferences. · Professional newsletters. · Press releases. · Governor’s Health Advisory Committee. · Public TV	11/01/2000	Ongoing	-  Professional education subgroup to create plan for ongoing professional education on newborn hearing screening, referral and follow-up. -  Disseminate plan to all hospitals and appropriate health care providers. -  Present at least 2 professional medical education/continuing ed. units at professional association meetings.
1.8.  By November 1, 2000 and ongoing, develop plan for parent/public education and information regarding newborn hearing screening, diagnosis and early intervention. · Pamphlets (with audiologists, physicians, hospitals, consumers) · WIC/Home Visiting/Baby Care/Head Start/Early Start/Prenatal Classes/New Beginning newsletters/DOH web page · Public TV	11/01/2000	Ongoing	-  Develop appropriate public education message with agency Public Information Officer and Office of Health Promotion. -  Disseminate such messages through avenues listed. -  Utilize public television programming on newborn health to inform residents of newborn hearing screening program.

 

PROJECT ACTIVITIES TIME ALLOCATION TABLE

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2001 to March 30, 2002 State:  South Dakota

 

Objectives and Approaches	Start Date	Completion Date	Tracking/Evaluation Methods
Objective 2.  By March 30, 2002, 75% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary.   2.1.  By April 1, 2001 and ongoing, convene quarterly meetings of the Newborn Hearing Screening Workgroup. 2.2.  By April 1, 2001 and ongoing, continue to link infants identified with hearing impairment with the infant’s medical home, family support and early intervention. 2.3.  By April 1, 2001 and ongoing, continue with professional and parent/ public education and information regarding newborn hearing screening, diagnosis and early intervention. 2.4.  By April 1, 2001 and ongoing, collect, analyze and report on the status of newborn hearing screening in South Dakota and the extent to which the program is linked to the infant’s medical home, family support and early intervention. 2.5.  By October 1, 2001, finalize and refine reporting mechanism. 2.6.  By January 1, 2002, finalize and disseminate recommended screening protocols/guidelines. 2.7.  By February 1, 2002 and ongoing, provide training to hospitals on the recommended newborn hearing screening protocols and guidelines.	04/01/2001 04/01/2001 04/01/2001 04/01/2001 10/01/2001 01/01/2002 02/01/2002	Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing Ongoing	-  Convene workgroup quarterly meetings. -  Disseminate screening protocols to hospitals not currently screening. -  Place screening protocols on DOH web site for easy availability.

 

PROJECT ACTIVITIES TIME ALLOCATION TABLE

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2002 to March 30, 2003 State:  South Dakota

 

Objectives and Approaches	Start Date	Completion Date	Tracking/Evaluation Methods
Objective 3.  By March 30, 2003, 90% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary. 3.1.  By April 1, 2002 and ongoing, maintain and sustain established program.	04/01/2002	Ongoing	- Annually monitor newborn hearing screening rates by continuing existing survey so time trend analysis is possible. - Establish guidelines for facilities to use to evaluate their own follow-up and treatment protocol implementation. - Collect self-evaluations annually.

 

PROJECT ACTIVITIES TIME ALLOCATION TABLE

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2003 to March 30, 2004 State:  South Dakota

 

Objectives and Approaches	Start Date	Completion Date	Tracking/Evaluation Methods
Objective 4.  By March 30, 2004 and ongoing, maintain program that will assure 90% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary. 4.1.  By April 1, 2003 and ongoing, maintain and sustain established program.	04/01/2003	Ongoing	- Annually review the institutionalization of the program tasks into DOH activities with the Workgroup.

 

PERSONNEL ALLOCATION CHART

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2000 to March 30, 2001   Project Year:  1     State:  South Dakota

 

Objectives and Approaches	Staff by Title and Consultants in Person Days
	Project Director	Data Staff	Epidemio- logist	Workgroup	Audiology Consultant	CSHS Staff	Medical Consultant
Objective 1.  By March 30, 2001, develop state infrastructure necessary to provide technical assistance and program support to physicians, hospitals, parents, and others to facilitate newborn infant hearing screening. 1.1.  By April 1, 2000, identify DOH staff to coordinate the newborn hearing screening program for the state. 1.2.  By May 1, 2000 and ongoing, provide technical assistance to facilities not currently providing hearing screening to assist in establishing a screening program within their facility (i.e., equipment, protocols, training, referral mechanisms, etc.). 1.3.  By September 1, 2000, establish the Newborn Hearing Screening Advisory Workgroup. 1.4.  By September 1, 2000 and ongoing, develop draft recommended screening protocols and guidelines for newborn hearing screening for use in hospitals. 1.5.  By September 1, 2000 and ongoing, develop and pilot reporting mechanisms to collect information from hospitals regarding number of babies born at the hospital, percentage of babies successfully screened, percentage of babies referred, percentage of babies rescreened and/or diagnosed, number of babies identified with hearing loss, and quality assurance indicators. 1.6.  By September 1, 2000 and ongoing, develop procedures for linking newborn screening program with the infant’s medical home, family support and early intervention (Part C). 1.7.  By November 1, 2000 and ongoing, develop plan for professional education and information regarding newborn hearing screening diagnosis and early intervention. 1.8.  By November 1, 2000 and ongoing, develop plan for parent/public education and information regarding newborn hearing screening, diagnosis and early intervention.	2 20 12 20 20 20 18 18	2 50	2 2 3 5	4 4 4 4 4 4	20 12 25 10 10 10 10	80 8 8	1 2 3 3 3

 

PERSONNEL ALLOCATION CHART

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2001 to March 30, 2002   Project Year:  2     State:  South Dakota

 

Objectives and Approaches	Staff by Title and Consultants in Person Days
	Project Director	Data Staff	Epidemio- logist	Workgroup	Audiology Consultant	CSHS Staff	Medical Consultant
Objective 2.  By March 30, 2002, 75% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary.   2.1.  By April 1, 2001 and ongoing, convene quarterly meetings of the Newborn Hearing Screening Workgroup. 2.2.  By April 1, 2001 and ongoing, continue to link infants identified with hearing impairment with the infant’s medical home, family support and early intervention. 2.3.  By April 1, 2001 and ongoing, continue with professional and parent/ public education and information regarding newborn hearing screening, diagnosis and early intervention. 2.4.  By April 1, 2001 and ongoing, collect, analyze and report on the status of newborn hearing screening in South Dakota and the extent to which the program is linked to the infant’s medical home, family support and early intervention. 2.5.  By October 1, 2001, finalize and refine reporting mechanism. 2.6.  By January 1, 2002, finalize and disseminate recommended screening protocols/guidelines. 2.7.  By February 1, 2002 and ongoing, provide training to hospitals on the recommended newborn hearing screening protocols and guidelines.	10 20 20 20 20 20 20	2 50	2 6 2 2	4 7 6 7	12 14 14 14 14 15 14	80 16	2 3 3 2 2

 

PERSONNEL ALLOCATION CHART

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2002 to March 30, 2003   Project Year:  3     State:  South Dakota

 

Objectives and Approaches	Staff by Title and Consultants in Person Days
	Project Director	Data Staff	Epidemio-logist	Workgroup	Audiology Consultant	CSHS Staff	Medical Consultant
Objective 3.  By March 30, 2003, 90% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary. 3.1.  By April 1, 2002 and ongoing, maintain and sustain established program.	130	52	12	24	65	96	12

PERSONNEL ALLOCATION CHART

Project Title:  South Dakota Newborn Hearing Screening Program

Project Director:  Nancy Hoyme

Budget Period:  April 1, 2003 to March 30, 2004   Project Year:  4     State:  South Dakota

 

Objectives and Approaches	Staff by Title and Consultants in Person Days
	Project Director	Data Staff	Epidemio- logist	Workgroup	Audiology Consultant	CSHS Staff	Medical Consultant
Objective 4.  By March 30, 2004 and ongoing, maintain program that will assure 90% of infants born in South Dakota will be screened for hearing impairment and referred for appropriate follow-up and treatment as necessary. 4.1.  By April 1, 2003 and ongoing, maintain and sustain established program.	130	52	12	24	65	96	12

Process and outcome evaluation activities are established as ongoing priorities throughout the duration of the grant.  In order to ensure that the goal and objectives of this project are achieved and to guide ongoing activities through the grant period, these activities have been specified by actual task in the project methodology (see page 18).  Each workgroup meeting will consist of some review and discussion of evaluation progress so that evaluation remains a key priority throughout the duration of this grant.  As necessary, process evaluation findings will be used to alter interactions with participating delivery hospitals.  For example, if evaluation tasks such as analyzing the newborn hearing screening data submitted by a given facility show that the facility false positivity rate has increased greatly during the past six months, the project coordinator would then work with the facility to determine the reason for this change.  If, upon review of the data, the infrastructure for the hospital to conduct newborn hearing screening was documented as having changed substantially, the hospital could be classified as action versus maintenance in terms of institutional behavior change and the workgroup could target stage-of-behavior-change specific assistance to that delivery hospital.

The person who will coordinate evaluation activities is the Project Coordinator, but specific tasks will be carried out by various people:  evaluation data analysis (MCH statistician, State Epidemiologist), documenting Workgroup activities (MCH secretary).