2024 Early Hearing Detection & Intervention Conference
March 17-19, 2024 • Denver, CO
| Investigating Barriers to Access and Delivery of NS-ABR in California’s San Joaquin Valley Pediatric Population
Investigating Barriers to Access and Delivery of NS-ABR in California’s San Joaquin Valley Pediatric Population
Joint Committee of Infant Hearing (JCIH)’s Early Hearing Detection and Intervention (EHDI) guidelines recommend that all infants who fail the initial hearing screen, adhere to 1-3-6 benchmarks. Per these guidelines, diagnostic auditory brainstem reflex(ABR) testing is the gold standard to confirm the presence of sensorineural hearing loss by 3 months. For successful completion of ABR, deep sleep state is favored hence the procedure is preferably conducted while the infant is under natural sleep(NS) before attempting sedation — to avoid complications. Prior analysis of our patients identified repeat ABR as a source of delay in diagnosis, and by extension, initiation of amplification and early intervention. Our Central Valley (California) population was noted to be particularly vulnerable, owing to these patients’ significant distance from any major tertiary pediatric academic center, variable levels of healthcare literacy, as well as language and/or beliefs that may be incongruent with those of their health care team.
To generate testable hypotheses regarding sources of delay in EHDI, we used a consensual qualitative research framework. Semi-structured interviews were performed with 10-15 families and 5 practicing audiologists to determine recurrent themes in barriers to accessing ABR. Emerging themes in these interviews included challenges traveling with an infant (such as disruptions to their feeding as well as sleep schedule), frustration over multiple ABR visits causing interference with daily obligations, and dissatisfaction over lack of representation in preparatory resources. Families also voiced appeal — to the research team — for providers to design optimal interventions aimed at overcoming these barriers, including, but not limited to, telehealth resources.
These themes are currently being utilized to design a subsequent interventional study. While further content analyses are planned, highlighted barriers describe the unique challenges of our Central Valley families and guide further intervention to optimize EHDI pathways for our center and California-at-large.
- By the end of this session, the attendees shall be able to identify sources of delay in EHDI as experienced by vulnerable populations in the state of California.
- By the end of this session, the attendees will be able to determine potential interventions which may eliminate barriers to accessing ABR.
- By the end of this session, the attendees will be able to describe the process and purpose of undergoing ABR from the perspective of families.
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Presenters/Authors
Dylan Chan
(Co-Author), University of California, San Francisco, Department of Otolaryngology-Head and Neck Surgery, dylan.chan@ucsf.edu;
Dylan Chan, MD, PhD, FAAP, is Professor and Director of the Children’s Communication Center (CCC) in the Department of Otolaryngology – Head and Neck Surgery at the University of California, San Francisco. He received his PhD in Auditory Neuroscience from the Rockefeller University and MD from Weill Medical College of Cornell University. Dr. Chan completed his ONHS residency from Stanford University, followed by a Pediatric Otolaryngology fellowship at Seattle Children’s Hospital. He is the AAP EHDI California Chapter 1 Champion and Regional Network Liaison for the AAP EHDI program in California.
In 2014, Dr. Chan established the UCSF Children’s Communication Center, which is devoted to delivering multidisciplinary care for families of deaf and hard of hearing children, performing community outreach and education, and conducting clinical and translational research projects. By addressing existing shortfalls in care delivery and developing novel interventions, he hopes to significantly impact hearing health in children.
ASHA DISCLOSURE:
Financial -
No relevant financial relationship exists.
Nonfinancial -
No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
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Financial relationship with N/A.
Nature: Work was funded by the Patient-Centered Outcomes Research Institute (PCORI).
Nonfinancial -
No relevant nonfinancial relationship exists.
Amritpal Singh
(Primary Presenter,Author), University of California, San Francisco , amritpal.singh@ucsf.edu;
Amritpal Singh is currently a third-year medical student at the University of California, San Francisco (UCSF) School of Medicine and one of the candidates of a tailored medical education track called the San Joaquin Valley Program in Medical Education (SJV PRIME). In accordance with the mission of this program, his research interests lie in working with the underserved populations to help eliminate barriers to healthcare and improve the quality of care provided to vulnerable individuals. Particularly, he is passionate about exploring how disadvantageous socioeconomic status can lead to poor health outcomes.
ASHA DISCLOSURE:
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No relevant financial relationship exists.
Nonfinancial -
No relevant nonfinancial relationship exists.
AAA DISCLOSURE:
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No relevant financial relationship exists.
Nonfinancial -
No relevant nonfinancial relationship exists.
Jacqueline Weinstein
(Co-Author), University of California, San Francisco , jacqueline.weinstein@ucsf.edu;
Dr. Jacqueline E. Weinstein is a pediatric otolaryngologist and head and neck surgeon at the UCSF Benioff Children’s Hospital. She cares for children with airway abnormalities; disorders of speech, voice and swallowing; hearing loss (present from birth or developed later); thyroid disease; head and neck masses; sleep-disordered breathing; and sinus disease.
Weinstein's research focuses on how hearing loss impacts the way children process and interpret sound, with the goal of developing new treatments for pediatric hearing loss. She is also interested in socioeconomic factors that influence access to timely hearing care. In additional research, she has extensively examined the connection between obstructive sleep apnea (when breathing stops intermittently during sleep because of an airway obstruction) and laryngomalacia (a congenital condition in which a structural problem with the larynx – or voice box – causes noisy breathing in infants), as well as complications of sinus disease in children.
ASHA DISCLOSURE:
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AAA DISCLOSURE:
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Emily Taketa
(Co-Presenter,Author,Co-Author), University of California, San Francisco , emily.taketa@ucsf.edu;
Emily Taketa is a first-year medical student at the University of California, San Francisco School of Medicine and originally from Thousand Oaks, California. She earned a B.S. in both Biology and Child Study & Human Development at the Tufts University. While at Tufts, she developed a passion for serving Deaf and hard of hearing communities through learning American Sign Language and working with the neuropsychology team at the Deaf and Hard of Hearing program at Boston Children’s Hospital. After graduation, she conducted research with the UCSF Children’s Communication Center, as well as taught preventative hearing health lessons to local SFUSD fourth-grade classes. Her current research interests include health disparities and accessible care for pediatric populations with neurodiversity and hearing differences. Outside of medicine, she enjoys painting and baking new lactose-free recipes with friends.
ASHA DISCLOSURE:
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Nonfinancial -
AAA DISCLOSURE:
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