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EHDI Annual Conference
EHDI 101
March 17, 2024
5:15 P.M. - 7:00 P.M. CDT
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	>> Welcome.  We're delighted to have you here for the EHDI 101 session.  
	We've designed this session primarily for people who haven't attended the EHDI Conference before but we welcome everybody else to be here too.  It's great to have all of you here.  By the time you leave, our goal is to provide you with the knowledge and the attitude to optimize your time here at the National EHDI Conference we've selected an all-star group of panelists that are very diverse from where they come from and what aspects of EHDI they are involved in.  
	There are professionals and parents, Feds and states, old-timers and first timers.  
	And we think that that diversity is a very important part of what makes EHDI successful so each of them will be talking about one particular aspect of EHDI and we'll suggest some resources that you can use to learn more and to do more.  To give you advice about how to get the most out of the EHDI Conference.  
	So just a question to start with, how many of you are here at EHDI for the first time?  
	So most of you.  But a few who have been here before.  
	So we welcome all of you.  
	We think that new people here at EHDI are in many ways the lifeblood of EHDI programs.  They bring new ideas they rejuvenate us, inspire us.  And we hope you will feel completely welcome and able to participate fully in this meeting.  
	I hope you will listen to what each of the presenters say because they have a lot of good information.  At the end we should have a few minutes for questions and answers.  
	But we will end for sure by 6:00 o'clock so that you can attend the opening reception and can put into practice the advice you get from the various speakers.  
	Along the way I hope that I will be able to help you understand a little bit about the history of EHDI.  My name is Karl White.  And I'll be the first member of this panel.  
	We have then six other members of the panel.  They will each introduce themselves very briefly.  
	Their bios are on the website if you would like to know more information about them.  
	So early hearing loss so permanent hearing loss is the most frequent condition that we can screen for at birth.  
	If you take 10,000 children born in this country, then 30 of them will have congenital hearing loss.  
	Compared to 11 with Down syndrome or 1 with (inaudible) so although these other conditions are not as frequent as hearing loss we often hear more about them.  And one of the goals of EHDI is to change that so that people know more about hearing loss and how it happens and which children are most likely to be affected.  
	So the children who are affected with hearing loss are also a very diverse group.  
	We sometimes think of children who are Deaf or hard of hearing as only those who have bilateral profound Deafness but the areas of the CDC show children identified in EHDI programs only about 14% of the children being identified are bilateral profound hearing loss compared to almost 50% who have unilateral or bilateral slight or mild hearing loss.  So it's a whole range of children and if these children are not identified early, they will lag behind in school, will have difficulty with their social interactions, difficulty developing language but fortunately if they do get those services then they can achieve on par with their peers who have typical hearing.  
	Just to make sure you are all awake what percentage of children who are Deaf or hard of hearing at 5 years of age were born Deaf or hard of hearing.  Someone shout out what you think it is.  I have great patience for silence.  What percentage?  Take a guess.  
	40%.  
	Any other guesses?  
	50%?  
	Any other guesses?  25?  
	Okay.  So we actually surprisingly don't have great data on this.  But at least there are at least double as many children who are developed or acquire hearing loss after the newborn period as are born with hearing loss so that's one of the areas that EHDI programs have begun to work on more in the last few years.  
	But those children also need as early identification as possible.  And services that will help them to develop language and social skills and cognitive skills.  
	So the idea of universal Newborn Hearing Screening is not a new idea we've been working on this for well over 100 years.  This is a quote from a couple of audiologists in the United Kingdom who said back in 1944 that there was an urgent need to develop techniques to identify children during that first year of life.  This is Walter Cronkite there are probably not too many in this audience who have listened to Walter Cronkite broadcasts but I have and he was often referred to as the most trusted man in America and he did a special on early identification of hearing loss the video is pretty bad because it's very, very old but he talked about some of the aspects of why it is important.  
	This is Marion Downs who probably more than any other single person is responsible for where we are today with early identification of hearing loss.  She was featured on that Walter Cronkite special.  She had this to say.
	>> Audiologists Marion Downs was among the first to recognize that whatever the cause of an infant's hearing loss, each waking hour, each day, counts.  
	>> It is vitally important that they be identified early, early in life.  
	And we think early really means at birth.  
	>> So that's as true today as it was then.  That we need to identify children as early as possible that each waking day counts.  
	Now, Marian went on to establish what's called the Joint Committee on Infant Hearing.  Back in 1969.  And the Joint Committee has since that time issued periodic Position Statements that give advice about how we should identify children with hearing loss and provide services to them.  
	And it's often referred to as the Bible of Newborn Hearing Screening programs.  If you are not familiar with the JCIH position papers, you can find them on our website.  At infanthearing.org or on the JCIH website at JCIH.org.  
	Now, prior to about 1990, we didn't have nearly as good of tools as we have now and I want to spend just a second talking about the history of early identification of hearing loss because it's important to reflect on that and to know where we come from and so Auditory Brainstem Response has been available since the early 1970s.  It was really very effective.  But it was also for that time very expensive.  So it was very difficult for people to justify screening all babies with Auditory Brainstem Response because of the expense and relatively low incidence so I said hearing loss is the most frequent condition we can screen for at birth but it's still only about 3% 1,000 just to give you an idea of how far we have come this is another clip from that Walter Cronkite video showing at that time the new technology that was available.  
	>> To identify hearing loss in infants exist.  New electronic instrumentation is revolutionizing this work.  In particular the brainstem  evoked response test called the BER.  A BER test such as this one at Albert Einstein Medical Center in New York can be conducted even while the infant is sound asleep.  
	A test sound, a series of clicks, is played over earphones.  
	Minute electrical signals picked up from the scalp show whether audio information is reaching the brain.  A computer sorts the signals.  And if there is a problem, it tells the doctor where it is.  
	>> So it was possible but it was quite a to-do to hook a baby up and do Auditory Brainstem Response it took a lot of time was expensive and isn't nearly what we have today I'll show you in a few minutes because Auditory Brainstem Response was so expensive to do people suggested maybe we should only be looking at babies who had high-risk indicators.  Things like low birth weight or a family history of hearing loss or various congenital or prenatal or postnatal infections.  Those high-risk indicators affected about 10% of all babies.  
	And for a while was what was recommended by the Joint Committee on Infant Hearing.  But again, it wasn't nearly as effective as we needed it to be.  Only about 50% of all children with congenital hearing loss exhibit one of those high-risk indicators and only about 2% of those with a high-risk indicator are Deaf or hard of hearing.  
	So it was a very inefficient process for identifying babies.  
	Then in the mid 1980s we began experimenting with some new technology.  So ABR became automated ABR which was much simpler to use, not nearly what you just saw and also the discovery of what's called otoacoustic emissions let me show you a very short clip we developed a number of years ago for parents in prenatal education classes that explain these two technologies.  
	>> Sofia.
	>> How can your baby's hearing be checked?  Thanks to advances in technology, we can now check a baby's hearing shortly after birth.  
	Your healthcare staff is concerned about your newborn's hearing because 1 out of every 300 babies is born with a hearing loss.  Children who cannot hear clearly will often have trouble learning to communicate that's why it's important to check or screen each newborn's hearing using one of two safe simple and painless procedures.  
	Let's watch an example of each.  
	One method is called OAE or Otoacoustic Emissions screening.  In this process a trained screener places a small earphone in the baby's ear that  emits a series of soft sounds.  The inner ear typically responds to these sounds by producing echoes called Otoacoustic Emissions.  Which are analyzed by the screening equipment.  
	Another method is called AABR or automated Auditory Brainstem Response screening.  In this process a trained screener places bandaid-like sensors on the baby's head.  Soft sounds are played into the baby's ear, these sensors analyze the brain's response to the sound.  
	No matter which method is used in a few minutes the screening is finished and the result is displayed.  
	>> So this technology has remained largely unchanged since that time.  In 1988 we started the Rhode Island Hearing Assessment Project which demonstrated on a large scale that you really could screen all babies for hearing loss.  And identify about 2.5 to 3 per 1,000 with permanent hearing loss.  That data along with results from several other smaller studies was used by the National Institutes of Health in 1993 in a conference that they had to develop a consensus about early identification of hearing loss.  And they recommended that all children should be screened for hearing loss before they left the well baby nursery.  
	Now, many of us assumed at that point that this would just take off over night.  That we had proven it worked and that soon all babies would be screened.  At that point about 6% of all babies were being screened and as you can see from this slide it took another 10 years to get over 90%.  Now we've hung fairly stable for the last 10 years at 98 to 99% of all babies in the United States being screened for hearing loss.  
	When we first started doing Newborn Hearing Screening I think this cartoon summarizes pretty well what happened.  So there was an awful lot of work in those early years that went into determining who should do the screening, when it should happen, what kind of equipment should be used.  Should you screen babies more than once, et cetera, et cetera but then there was almost the assumption that once we got the screening protocol worked out a miracle would occur and everything would be just like it should be but what we found in the last 15 years is there's an awful lot of other things that need to be considered in putting together an Early Hearing Detection and Intervention system.  Not only do we have to learn a lot about how to do diagnosis and how to refer and enroll these children in Early Intervention Programs.  But what kinds of Early Intervention Programs to provide.  
	We wanted to make sure that those systems were compatible with the medical home that the child was participating in.  
	Developing data management systems.  
	And using that data for program evaluation and for policy decisions.  
	And then creating better family support programs.  
	So speakers after me will address all of those issues in more detail.  
	But we have seen that the average age at which children are being identified has dropped dramatically.  So from 2.5 to 3 years of age down to now 2 to 3 months of age but remember these are averages in these studies so that still means there are about half the children not being identified until after 3 months of age so we still have a lot of work to do.  
	And Marian summarizes how we should do that.  This is a picture from -- or a video from about 15 years ago.  Marian passed away a few years ago but I think her advice is still right on.
	>> Do remember that screening is nothing without good follow-up and a good intervention program.  And one challenge comes after the other.  I sort of like to think of this 40-year period of when we were trying to get newborn screening in, I like to think of it as similar to Gandhi's work in India I want to read you what he says and I think it's pertinent to all of us.  
	First, they ignored me.  
	Then they laughed at me.  
	Then they fought me.  
	And then we won.  
	America, keep on winning.  
	>> So that's where we are today and I hope you'll take her advice to heart.  
	So I've asked each of the speakers to just very briefly give a little bit of advice about how you can get the most out of the EHDI Conference.  I want to focus again on the diversity of people who attend this conference.  
	This is a list of what the registrants look like this year.  As you can see, they represent very many different organizations and applications of how we help children who are Deaf or hard of hearing I think that diversity is our strength and I hope you will seek out people who have different opinions and different ideas than you came with and learn from those ideas.  
	I also hope that you will visit the exhibits.  
	We have a lot of people here who have developed products and materials to help enhance Newborn Hearing Screening.  And there's a lot that we can learn from them.  
	And then finally, I wanted to give you this quote from Helen Keller.  
	It said, the world has moved along not only by the mighty shoves of its heroes but also by the aggregate of tiny pushes of each honest worker.  
	I think we all have a role to play in moving EHDI forward.  
	And this little logo at the bottom was developed by some of the EHDI Coordinators a couple of years ago, #EHDItogether.  Everyone here doing it together.  
	That's really what makes EHDI successful.  And we'll turn the time now to Sandra from the HRSA MCH program.  
	>> Hello everybody, we can relax I'm pretty chill I'm pretty calm I'm Sandra actually I prefer to hold the microphone I'm here from the Health Resources and Services Administration also known as HRSA I apologize there are a lot of Government acronyms I will try my best to not use them as often but I know I will use them.  So I have two things I want to accomplish one is to really provide an illustration of how EHDI fits into the priority of the Federal Government.  And the second thing is I need to do this in under 10 minutes because that is all the time I have been allotted.  
	So with that, if you think about the Government, we have a bunch of departments.  And one of those departments includes the Department of Health and Human Services.  
	Well within the Department of Health and Human Services you'll find three agencies the Centers for Disease Control and Prevention, the CDC, National Institutes of Health, NIH and HRSA Health Resources and Services Administration, where you will find some footprint, handprint, of where EHDI fits into the portfolio of those programs.  
	Within HRSA, we have six bureaus of which the Maternal and Child Health Bureau or MCHB is a part of.  
	You'll see that we have a specific mission that's focused on the health, safety and well-being of the MCH population.  What you'll also see is that we have a Strategic Plan, which includes four areas of focus.  
	Access.  Equity.  Capacity.  And impact.  
	And we believe that these are the pillars in achieving in America where all mothers, children and families are thriving to reach their full potential.  The blueprint which we'll discuss shortly, is something that's part of this Strategic Plan.  
	Okay.  
	So we have HRSA.  We have MCHB.  And then if we drill down any further, we have the Division of Services for Children with Special Health Needs which is where the EHDI program sits.  
	What you'll see is we recently released the Blueprint for Change which is the framework for the field for the next 10 to 15 years about advancing the services or the system for Children and Youth with Special Healthcare Needs.  In this blueprint you will find the four areas that we've been told and we believe we've been told by families and these are the four areas that will help us achieve our vision that Children and Youth with Special Healthcare Needs enjoy a full life from childhood through adulthood and thrive in a system that supports their social, health, emotional needs, ensuring dignity, autonomy, independence and active participation in their communities.  
	I did not know there was animation.  Sorry about that.  
	Okay.  So Karl kind of spoke about this.  MCHB has been an early proponent of universal newborn screening and that was really in the 1980s with the Rhode Island Hearing Assessment Program.  Since then we provided continuous support in funding to support the -- to reduce the Loss to Follow-up to make Newborn Hearing Screening programs in the medical home use quality improvement methods and engage families.  Now we can't talk about EHDI's framework without talking about the legislation.  
	So in 2000, that's when Congress passed the first legislation to support the development of state and territory Newborn Hearing Screening and intervention programs.  
	By 2017 the legislation was reauthorized but this time they kind of called out some specific things including expanding hearing screening from newborns up to age 3.  Deaf and hard of hearing adult consumers to family supports were recognized.  And lastly it said that information provided to families should be accurate, comprehensive, up to date, and evidence based as appropriate to allow families to make important decisions for their children in a timely manner.  
	Fast forward five years later in 2022 it was reauthorized and it outlines specific responsibilities for HRSA, CDC, and the NIH.  
	What are those responsibilities?  Glad you asked.  
	So HRSA, our focus is on the EHDI system.  And that's really making sure that we have support for state and territory EHDI programs and the effectiveness to screen newborns, infants and young children to ensure prompt evaluations and diagnosis for the kiddos that require additional evaluation and to make sure that appropriate support is not only available but also accessible.  
	Since EHDI has been funded or if you think about the evolution of EHDI we really made some great strides.  Before 1993 lessor fewer than 1 in 10 newborns were being screened for hearing loss but now nearly all are screened.  Since HRSA's Early Hearing Detection and Intervention Program started, the states and territories have had significant success in identifying and getting services for newborns and infants with hearing loss.  
	As a result each year in the United States some 5,000 infants who are Deaf or hard of hearing them and their families have the opportunity to experience improved outcomes in the child's language development, ASL or spoken language.  As well as improved outcomes in the child's overall well-being.  So this is just an illustration again if you're thinking about the U.S. Department of Health and Human Services you will track EHDI back to one of these three agencies.  
	But it doesn't just stop there.  
	We work across departments in order to really make EHDI system complete for our programs to be successful, it does require that we work with other programs at the Federal level such as the Part C program which is housed under the Department of Education.  
	Now, you will see this illustration that we call the EHDI pipeline or the EHDI pathway.  The ultimate goal of EHDI is to improve language outcomes so we should consider whether Deaf or hard-of-hearing children are achieving language milestones.  The ability to use language whether ASL or spoken predicts reading, communication and many other outcomes that families and society think really matter.  
	So state and territory EHDI programs should start on the left of this diagram to ensure that every child is screened and gets a diagnosis.  
	Other key steps that are critical in a family's journey include support, connecting to medical care and ensuring appropriate early intervention services that emphasize a language-rich environment.  Screening and initial connection to services is just the start of a family's journey to ensuring that their child is able to play, go to school and become a healthy adult.  
	So if we look at the funding portfolio of HRSA, looking towards the future.  When I say future, I mean April 1st.  So in a couple of weeks, right?  The way we structure our programs will change.  We have funding to support 59 grants to states and territories for EHDI system and infrastructure.  
	We have 12 supplements that we provide through the audiology LEND program to support audiology trainees and then we have 3 cooperative agreements.  Three technical centers which will focus as a national -- they will work together as a national center but they each have their distinct focus areas.  The ICC or the implementation and change center will focus on providing technical assistance to states and territories the FL3 which is the Family, Language and Learning Center will support family engagement and support and then we have the provider Education Center they will help increase confidence and provide training for the healthcare providers and allied health professionals/providers that work in the EHDI system so they each have their distinct focus but as a network they are responsible for technical assistance and training, policy analysis and assessment, partnership building and communication dissemination and evaluation.  
	You will find my team.  I think we're pretty dynamic.  I am biased and I am okay with that.  
	You will see my Branch Chief, Treby Brown as well as my Team Lead who is on the far right really quickly in addition to myself we have Shelby Graves, Dr. Akila.  Henny and Jenny and Dana that serve as a part of our team.  I will be honest I forgot to include the slide with the advice.  So I queried the team last night.  And one thing that we think will help you is connections whether you know someone in your state or outside of your state we will encourage you to meet people you don't know.  Go to a session that you believe is outside of your wheelhouse because you'll really see how connected you are to the EHDI system.  
	Even with the part that you do.  
	If you say hello, I'm pretty sure my colleagues will welcome a discussion or a dialogue with you.  We are pretty friendly.  
	And this is contact information as well as information about HRSA.  
	So thank you for your time.  I will now invite Dr. Erica Odum from the CDC to tell you more about how CDC fits into the big system of EHDI.  Thank you.  
	>> All right.  Good evening, everyone, we almost made it through Day 1.  Right?  
	So I'm going to start this presentation.  I'll be talking about CDC and our role in EHDI.  
	I am the Team Lead for the EHDI program at CDC.  
	And we sit in the National Center on Birth Defects and Developmental Disabilities in the Division of Human Developmental Disability and my team is housed within the Disability and Health Promotion Branch.  
	Okay.  
	So I'm going to start this presentation with a statistic you probably have heard many times.  
	Nearly 1 in every 500 live born infants is born Deaf or hard of hearing.  And this is a number that comes from data submitted by states and territories across the United States.  Supported by the hard work of our state Health Department staff who work with hospital teams.  Who work with audiologists and who work with early intervention providers.  
	This number is so important because we know that undetected hearing loss can cause delays in children's speech, language, social and emotional development.  
	Which can have lasting impacts for children reaching their individual goals.  
	And as a result, public health and the EHDI community has identified these 1-3-6 benchmarks.  And the first benchmark is to understand infants who -- we hope that infants by 1 month receive that first screening.  
	And then among those infants that do not pass that first screening, that they receive a diagnostic evaluation by 3 months.  
	And then of those infants diagnosed with permanent hearing loss, they are enrolled in early intervention by 6 months.  
	So CDC's role.  Our role is to support children who are Deaf or hard of hearing by funding public health programs to develop data collection systems, which we call the EHDI Information System.  
	CDC does not recommend any particular education or communication option as a part of our funding.  But we focus on improving systems of care through the evidence of data.  
	Data collection and use of data by public health programs is integral to improving the EHDI 1-3-6 system and reporting actions to account for all infants who should receive timely follow-up services.  
	CDC supports public health programs in states and territories by providing technical assistance regarding data collection and evaluation of their programs.  
	We also report national data and work with public health programs to ensure data quality and timely analysis of data.  
	We help provide the evidence base using data to inform programmatic decisions to support positive develop outcomes among in-- developmental outcomes among infants who are Deaf or hard of hearing.  
	CDC also coordinates with HRSA and OSEP as Sandra mentioned in her slides.  
	We work with one another to keep track of NOFO requirements.  We also work together to align definitions.  And we ensure that ideas and information are shared while also providing technical assistance to states and territories.  
	And for CDC, we'll get to the slide, we don't fund all states and territories.  But we do provide technical assistance when asked of non-funded states so you'll see with our Hearing Screening and Follow-Up Survey data we call it HSFS data we have more than 50 territories and states that contribute to that data collection effort.  
	So this is just a reiteration of the previous slide.  EHDI data is a critical tool and a driver of system improvements.  
	Data is used by our public health departments to inform program decisions that impact infant hearing screening and follow-up services for children who need them.  
	While states and territorial programs are our primary data collectors, CDC also uses the data that they provide to us to produce these national statistics like the 1 in every 500 babies born that I said at the beginning.  
	We report national statistics to our partners like HRSA for their Congressional justifications.  We also report statistics to the National Institutes of Health with our Healthy People metrics, which gives us an idea across the nation about how we're doing on that 1-3-6.  
	So the EHDI IS, which is our EHDI Information System, it's the actual data collection tool or data systems that public health departments use to track families and children who need those follow-up services.  
	It helps programs ensure that children and families are not lost to documentation or lost to follow-up.  And that simply means are they in the system and we just don't know where they are.  Like we have tried to contact them but they haven't responded to us.  
	Or they are in a data system, we just haven't transferred that information to our state EHDI IS program.  
	So CDC encourages active use of EHDI data by state programs and partners to identify what they can do to identify every child that needs follow-up services receives it in a timely manner in hopes of meeting those 1-3-6 benchmarks we also have this EHDI guidance manual that we put out at CDC.  
	It explores the value of the EHDI Information System.  Not just as a data collection system.  But as a tool to drive program decisions and to understand if state Health Department programs are really serving all the infants that they can or should be serving in terms of receiving those follow-up services.  
	As mentioned previously, CDC funds a certain amount of state and territories.  
	Using the Cooperative Agreement mechanism.  And our largest Cooperative Agreement funds 39 recipients to advance state and territories' capacity to report, analyze and provide patient-level data to ensure all infants receive those EHDI services.  
	This patient-level data and I'm saying this for family members who are present, this patient-level data is deidentified we don't have very name-level information on these infants.  We are working to ensure that we do get some sociodemographic information because that helps states understand where infants are in their state.  Are they receiving services equitably across infants in different population groups.  
	CDC also provides to our state Health Department and territory programs, we provide information around standardizing data element definitions.  
	And we also provide them with validation tools for the data that they submit to CDC.  
	So this is a graph, a picture, of all of the funded states, the 39 states and territories that are funded in our current Cooperative Agreement.  
	CDC also still works with states and territories to collect aggregate data.  
	And we do this through the Hearing Screening and Follow-Up Survey.  
	The HSFS is voluntary and we use it to inform those national numbers that I spoke about at the beginning.  
	And our most recent data was published in January for babies born in 2021.  
	So we have data available going all the way back to 2005 to 2021.  
	Our second Cooperative Agreement is the Outcomes and Developmental Data Assistance Center for EHDI and we refer to that as ODDACE the recipients are the agents of the University of Colorado at Boulder it's a collaborative effort between CDC and the University of Colorado where we are gathering data on infants.  We do multiple assessments related to language outcomes.  
	And last but not least, this is my slide on how to engage in the EHDI Conference.  
	So as you'll note, CDC is all about data, data, data.  That's kind of what I said through the whole presentation, right?  So we have a number of presentations that will be hosted throughout the week.  The majority of them are happening on tomorrow.  
	We have some poster presentations.  As well as oral presentations presented by our team.  
	And so one excellent way of getting information about data related to EHDI programs, it's going to -- is going to some of these presentations.  
	A lot of the work we do are directly with our State Health Department and territorial program recipients.  So we don't have a lot of interfacing information outside of that about the specific data, other than when you go to our website, you can look at the HSFS data.  
	It's a lot.  We are working on presenting that data in a more digestible way for a wide variety of audiences.  
	But if you have a small inkling of interest in data, I encourage you to go to the CDC website.  Come to some of our presentations.  Ask us questions.  We're always -- we're very, very open to having questions about the data.  And what you can do.  
	We even got a question from a person that's entering grad school and going to be working on a dissertation soon.  And they are interested in data.  
	So any questions that you have about data, we encourage you to come to these presentations and ask us.  
	And last but not least, I just want to say thank you.  
	And next up we will have Linda Hazard presenting.  
	>> Hello, everyone, it's great to see all of these new faces and some familiar ones, too.  I'm Linda Hazard I'm the Program Director for the Vermont Early Hearing Detection and Intervention program.  
	But I'm here tonight to talk to you a little bit about EHDI programs in general.  
	So state EHDI programs are different state to state.  As has been mentioned in the previous two presentations, there are states and territories, 50 states, 9 territories.  
	The EHDI Federal legislation is for birth to 3 years of age.  
	And originally when EHDI started, it was a smaller area of birth to 6 months or birth to the first year.  
	So we have really expanded.  
	And I do want to mention that EHDI programs are lean, very lean, programs.  
	And work very, very hard to achieve the goals.  
	So all of us have HRSA funding.  
	And as Erica mentioned, there are 38 states and 1 territory that has CDC funding.  
	And sometimes there are other -- there's other state funding that's available to states.  And for example, in Vermont, we also have Newborn Hearing Screening fees that help support our program and sometimes some Title V funds but again that differs state to state.  
	So what are the EHDI program roles and general responsibilities?  To begin with, tracking and surveillance.  
	So the national benchmarks of hearing screening by 1 month, diagnosis by 3 months, and entrance into early intervention by 6 months of age.  
	And who do we collaborate with?  We collaborate with our birth hospitals across the state.  
	We collaborate with midwives, homebirth midwife practices.  We collaborate with primary care providers.  
	Diagnostic evaluations by 3 months of age, we collaborate with audiologists.  
	And I think there's a statistics out there that there are more audiologists currently retiring from the field than there are audiologists coming into the field so the LEND program is a wonderful way of encouraging audiologists to enter our field so that we have enough practitioners.  
	Entrance into early intervention by 6 months of age.  
	So we collaborate with our early intervention Part C providers.  
	And that's a very important relationship so audiologists referring onto Part C but also letting EHDI programs, keeping us in the partnership of all of this.  So we work closely with following up with families, following up with audiologists to ensure that these infants are moving on to an early intervention once they are diagnosed.  
	So the importance of collaboration with stakeholders, state, territory EHDI programs work to improve programs for screening, diagnosis and referral to early intervention.  
	We also know that family-to-family support is critical in all of our work.  
	Although we don't -- and we support early periodic screenings.  So in those infants that have high-risk factors, so ensuring those young children also receive follow-up screening.  
	And generally we do not have authority over the entities who provide these services.  So partnerships and collaborations become very critical.  
	So early intervention, what are some of the areas?  Language and developmental assessments.  And that is something that we will be working towards as EHDI states in the next HRSA agreements.  Family engagement so who do we work with, so family-based organizations.  It's different depending on your state so for example in Vermont we have a Hands & Voices chapter and we work very closely with our Hands & Voices group.  
	
	Another family-based organization is Family Voices.  
	And we realize the critical support in the EHDI world and our work of family-to-family support.  
	Meeting families where they are.  
	Monitoring of newborns with high-risk factors is another area we closely monitor.  Deaf and hard of hearing mentor programs is another partnership or a collaboration.  
	Family retreats.  
	Parent and professional trainings.  You know, for example, there's the CARE Project out of North Carolina that has family retreats and has workshops for professionals and parents.  There are other groups, also, that provide some wonderful opportunities for families, such as trauma-informed workshops and holding space.  
	So this just continues on a little bit more about EHDI, the importance of collaborating with stakeholders.  
	EHDI website development.  
	So make sure that you are aware of your EHDI website and you go to it and look at the resources available there.  
	EHDI programs often play a role in supporting emerging initiatives such as congenital cytomegalovirus, CMV screenings and education because education is also very critical.  
	Additionally early periodic screenings for children between birth and 3 years of age so as Karl mentioned there are almost twice as many infants that are born with hearing loss that are then diagnosed as Deaf/hard of hearing or deaf-blind between birth or 6 months of age and age 5.  
	EHDI advisory councils.  Our states and territories have advisory councils it's great to get involved and learn more about the EHDI system.  
	And family committees.  That's another area of collaboration and partnership.  
	So EHDI programs, the EHDI Coordinators also come together under the directors of speech and hearing programs and state and welfare agencies.  We just had our Board and Annual Meeting today.  
	So representatives serve on several national committees including the Joint Commission on Infant Hearing.  
	Additionally, as part of DSHPSHWA is what we call it for short or sometimes DPS if we're even shortening it more but we serve on other committees such as the audiology consortium which helps the health economics Board which also help in defining coding for audiology and other areas.  
	Family leadership, we partner with Family Leadership in Language & Learning, the FL3 led by Hands & Voices.  The American Academy of Pediatrics, AAP.  
	So you can see there's a lot of work being done within a variety of partners.  
	So how can you get the most out of the EHDI meeting?  
	Attend diverse sessions.  Look at things that you may -- that are very different from what you are familiar with.  Visit the exhibitors, talk to the exhibitors.  
	Talk to other state and EHDI territory representatives.  Talk to families.  Talk to Deaf or hard-of-hearing adults.  Check out Hands & Voices.  Check out the CARE Project online.  They are not -- they were not able to be here this time.  
	But most of all, have fun.  Reach out.  Talk to people.  
	And how to partner with your state and territory EHDI program.  Attend the stakeholders meeting.  
	Some stakeholder meetings will be held here.  Others will be held -- were held before or will be held after the EHDI Conference.  
	Understand the issues of your state.  
	Participate in your advisory councils.  Find out where they are being held.  
	Participate in learning communities.  
	Share your opinions.  
	And always reach out to your state EHDI Coordinators.  
	We are more than happy to help guide you and talk with you about our programs.  
	And I just have to end this with this is one of my favorite pictures, which in Vermont right now it's maple syrup season.  So these are our maple syrup twins.  
	Thank you for your attention.  
	I'm going to turn this over now to Lisa Kovax from Hands & Voices and the FL3.  
	>> Hello, everyone, I'm excited to be able to share some information with you about family support.  I'm the Director of programs for Hands & Voices headquarters and also on the Family Leadership in Language & Learning CORE Management Team.  
	So my introduction into the EHDI system was in 2000 when speaking of twins, my husband and I had very premature twins at 27 weeks gestation.  This is a picture of my son here.  
	And I am forever grateful for the EHDI system.  Because in my home state of Indiana, my twins were born in the year 2000 and they had just passed the Newborn Hearing Screening mandate.  
	And so I am telling you when you look at the far picture that's my husband and I with my son Anthony graduating college in 2023.  And I am here to tell you that the EHDI system is a reason why Anthony has had the incredible outcomes that he has had.  
	He is currently in school pursuing his Master's.  Will be receiving that in December.  And then going onto get his PhD in theological studies so again I just want to all of you in the EHDI system you are a part of making a difference in family's lives just like my family.  I would like to open with another story from a family that we recently received a quote from a research study looking at parent-to-parent support the mother shared that she was hanging on a bit in a limbo zone.  
	She said it was like there's something here but we just don't know exactly to what extent it was.  She said she was an emotional wreck every time she had an ABR appointment she said we had several of them to get a complete picture.  The appointments were really hard.  It felt like you were reaching out into the darkness.  And you don't know what exists out there.  
	But what this is going to be like or you're desperate to find a bridge to something that will help you feel more anchored.  Once I was connected to another parent, it gave me something to hold onto.  It gave me a sense of grounding and an anchoring within this new normal for our family.  
	Reading that quote from a family made me think that I couldn't think of a better way to talk to you about family support than to share that quote.  
	So what are families going through at this time of learning about this new information about their child?  
	Many families at this time entering into the EHDI system it's the same time that they might be learning to be a parent for the first time.  
	So just imagine that.  
	I was fortunate.  I had two other children before I had the twins.  
	So I wasn't a brand-new parent in that experience.  But many of our families are.  
	They maybe have never met anyone who is Deaf or hard of hearing.  So the information a all new to them.  And most importantly, there's this real urgency in moving forward because of the need for language acquisition.  I recently spoke to a mom in the UK who was sharing her story looking back on her journey.  
	And she said she was so stressed during this critical time that she really missed out when she reflects back she missed out on that pleasure of bonding with her baby.  Because it's such a short window of time.  
	So this mom that shared her story with me was highly resourced.  So it made me think, what happens to the families that we're working with that are not so highly resourced?  What's the impact on those families?  
	So this is where family support comes in.  The EHDI system can really make a difference in the outcomes of families.  
	Families in the EHDI system are diverse and the decisions that they make for their children can be complex.  
	It's important to understand that there really is no one path to communication and language that works for all families.  
	Families need the support of many to find what is going to work for their child and their family.  
	Access to family support increases a family's knowledge.  It improves the child and family quality of life and well-being.  And empowerment that ultimately promotes family's engagement in the language and communication for their children.  
	So where do we see parents in this EHDI system?  You know, when I first learned about EHDI, I thought it was just a program.  And I've quickly learned that EHDI is a big system.  It's audiologists.  It's otolaryngologists.  It's parents.  It's Deaf adults.  It's researchers.  
	It's data.  Scientists.  There's a huge system out there.  
	So my journey in the EHDI system began just being a parent myself.  And I got involved because I just wanted to learn everything that I can learn to help my child.  
	And there's many times we see parents, I see some of them sitting out in the audience right now, who then move into this next level of so they have been able to help their child and now they want to help other parents.  So they get into the parent-to-parent support.  And then finally, we see parents who start engaging in systems improvement.  So they are working at the systems level.  
	So we need to think about that we have parents in all three of those different domains and how can we support them and engage them in the EHDI system work that we're doing?  
	So a little bit about Hands & Voices.  Hands & Voices is a nonprofit organization that's been around for over 25 years.  We're a parent-driven organization so all of our chapters across the U.S. and Canada are led by parents themselves who have Deaf or hard-of-hearing children.  
	We rally around the idea that there is no one way that works for all kids.  Our motto is what works for your child is what makes the choice right.  
	And our vision is that all Deaf and hard-of-hearing get the opportunity -- Deaf and hard-of-hearing children get the opportunity to reach their full potential.  
	The FL3 center was first established in 2017.  And Hands & Voices would like to thank and recognize the Maternal and Child Health Bureau through the Health Resources and Service Administration for prioritizing family support as an integral part of the EHDI system.  
	The FL3 Center is here to increase state capacity for family-to-family support.  To develop family leadership.  And to engage Deaf and hard-of-hearing adults to families across state and territory EHDI programs and other EHDI system stakeholders.  
	If you are looking for support in your state or territory, the FL3 Center is here to support you in your efforts around family support, family engagement and family leadership.  
	We have a Technical Assistance Team that is divided into four different technical assistance areas that you see here on the map.  And we invite you to contact us.  
	We love to work with you.  
	Finally, about getting the most out of your EHDI experience.  It's very similar to what some of the others have said.  
	I hope that you will look into going into sessions that are maybe outside of your comfort zone.  Or your sphere of knowledge.  
	Connect with families like myself.  
	There's I think what did I see, Karl, 150 or something like that around 150 of us wandering around this meeting over the next few days.  
	Don't be afraid to ask them about their experiences.  It can really make a difference in the work that you do.  
	Thank you so much.  
	And I'm going to turn it over to Alyson now.  
	>> Thank you, Lisa.  
	Hello, everybody.  
	I am here to talk about early intervention component of EHDI.  And just curious, how many people in the audience who are early interventionists now or are going to be early interventionists early interventionists in the crowd, okay.  Great, over there.  That's my passion and that's why I'm here to talk about it so the I in EHDI stands for intervention.  I am Alyson and Dr. Odum mentioned one of the centers that is supported by the CDC is the ODDACE center we are all about language outcomes at the University of Colorado Boulder and I'm currently the Director of that center so what I want to do you today is tell you a little bit about some of the terminology that you'll be hearing about as you go to the various sessions over the next couple of days.  
	Somebody else earlier mentioned there's a lot of acronyms in our field.  
	I think probably every field has a lot of acronyms.  But it can get confusing and I want to highlight a few of the terms that I think you are going to hear over and over again to give you some understanding of when people say those terms what are they talking about.  
	So just quickly what is early intervention.  It's a little different than your typical speech therapy model in that the support that early interventionists give focuses a lot on the whole family.  
	And the caregivers of the child.  The parents or the guardians.  The grandparents, extended family.  
	So rather than early intervention being about directly you know sitting across from the child and doing your therapy, it's more about coaching the family in how to implement strategies that are going to meet their goals.  
	Whether it's improving their child's language skills.  Or keeping hearing technology on their child.  
	Or learning sign language.  Or whatever goals the family has for themselves or their family, the early interventionist is going to support those goals and work directly with the family.  So that they can then be implementing strategies every day, all day, that are going to help their child grow and develop skills.  
	And early intervention generally can focus on any of five areas.  Cognition.  Physical development.  Social development.  Self-help skills.  
	But the main aspect that we're typically working on with children who are Deaf or hard of hearing is their communication or their language skills.  
	So this is the terminology piece that I was alluding to just a minute or two ago.  
	So Part C.  Part C.  If you go to any sessions on intervention or anything related to intervention, I can almost guarantee the words Part C are going to come out of the mouth of the person who has the microphone.  
	So there's an umbrella Federal legislation IDEA which is the Individuals with Disabilities Education Act.  And that is a Federal law that provides free and appropriate education to eligible children who have disabilities.  
	That umbrella is what Part C and Part B sit under.  
	So Part C is mainly what you'll hear about at this conference.  Because that's the birth to 3 piece.  
	So it's early intervention.  Part C is early intervention for children with disabilities and Part C can include anything.  It's not necessarily children who are Deaf or hard of hearing.  It might be children with visual impairment.  Children who have cognitive impairments.  Children who are on the autism spectrum.  With or without a hearing difference.  
	And it's support to these children and their families and it's supported by Federal funding which is what makes it kind of I guess special and different than just early intervention in general as it's the Federally supported Early Intervention Program.  
	Part B, on the other hand, also sits under the IDEA umbrella.  And that's special education services for children from 3 to 21 years.  
	So preschool all the way through high school and then often life skills after high school up to the age of 21.  
	And another terminology or phrase that you'll often hear at this conference is the transition from Part C to Part B.  
	So there's a lot of work being done on making that transition smoother because it is going from two very different systems and two very different models basically going from services that typically are provided in the home and are centered on the family and the family's needs and coaching the family.  
	To optimize their child's development.  
	Whereas Part B is more going to school so it's the more typical education.  You go to preschool you go to elementary school, middle school, high school, et cetera.  
	So making that transition, it's kind of a big jump because of that really different service model.  And so you'll see sessions here about the transition from Part C to Part B and that's what people will be talking about when you see that phrase.  
	Let's talk a little bit more about Part C, what does it involve?  Because there's Federal dollars there's often Federal requirements which often go hand in hand when somebody gives you money, they want you to do certain things.  So a couple of the tenets of Part C are that any services, any goals that are developed, the intervention that's provided, is always done in collaboration with the parents.  
	And it's kind of perfect following Lisa and her information she just provided to you about family-to-family support is that Part C is all about families and giving families a voice and a say in what are the goals that they want to work on?  And working in collaboration with them.  
	Another tenet of Part C is that services are provided by qualified personnel.  
	The specific definition of that can vary a little from state to state.  
	But with the idea being that people who are working with families basically need to know what they are doing.  Right?  
	And typically these services are provided at no cost.  
	So that's what it's makes Part C a little different than just your general go for speech therapy kind of intervention.  Is generally if you go to a clinic and you're seeking speech therapy or any other intervention you're going to pay for it in one way or the other you'll pay for it with your insurance or private pay but the Part C services are typically provided to families at no cost.  
	The last piece I want to say about the requirements, because this is sort of probably assumed knowledge as you go to the presentations, is that early intervention through Part C is going to be provided in what they call the natural environment.  
	So when you hear that term, services in the natural environment or intervention in the natural environment, typically what they are talking about is the family's home.  But it can also be in the community.  
	So an early interventionist might go to a Gymboree class with a family or swimming lessons at the Y so things with the family would naturally access with the child either in their own home frequently or in the community.  
	So Part C isn't the only game in town when it comes to early intervention.  
	There are also a number of different types of intervention services that families seek out.  One of the most common in this field are what I would call specialty programs for children who are Deaf or hard of hearing.  
	Those are often provided by a School for the Deaf within the state.  But it's a little different than their oncampus school because early intervention is pretty much all about families choosing their -- the communication methodology that they feel works best for them and their child so while a School for the Deaf may in their school setting subscribe to a bilingual bicultural approach for ASL other schools might focus on Listening and Spoken Language typically those schools when they offer early intervention birth to 3 programs, there's much more flexibility in communication methodology choice.  So many families avail themselves of early intervention through these specialty programs, whether it's a private program.  Or a School for the Deaf program.  
	Some families also access private practice.  So early interventionists sometimes pro -- early intervention is sometimes provided by a speech pathologist or a psychologist who has their own private practice and then some families choose to go somewhere for their services so rather than having someone come to their home to provide early intervention, they prefer to go to a clinic setting or a hospital setting.  So that's another way that early intervention can be delivered.  
	And some families do it all.  So they have Part C interventionists come to the home.  They might get School for the Deaf services also probably in their home and then they may go out to the Children's Hospital down the street and join a toddler group or get individual speech therapy in that setting.  
	So early intervention can look different ways.  But Part C being probably the most common thing you'll be hearing about at this conference.  
	So why early intervention?  People have already alluded to this.  
	It's early in life in that birth to 3 period.  Where a baby's brain is most adaptable and in particular most adaptable to learning language.  
	And early intervention can change the child's developmental trajectory in terms of allowing them to meet the language milestones that they should be meeting based on their age.  
	So in terms of the connection to EHDI, EHDI starts with hearing screening.  Moves onto identification of hearing loss.  
	That if the child is identified early, that then allows for intervention to start early.  
	And there are numerous studies that have shown that if early intervention happens, intervention is started by 6 months of age, that the children are likely to have better outcomes in terms of their language and communication skills.  
	So some tips.  
	So everybody has mentioned the idea of you know stepping out of your comfort zone.  But one of the things I would say as a piece of advice is do a little preparation.  So this night of course you know go out, have fun.  If you're with people, dine with them.  Socialize.  
	But take a little time tonight if you haven't already to look through the program and see what interests you.  
	Because if you wait until you get here tomorrow, it's a little helter skelter and you're going to run into people you know and all of a sudden sessions are starting you're trying to see on your phone what's the next -- you know, what should I go to.  
	And what I've found for myself when I didn't plan ahead and then afterwards maybe I would take a look or someone would mention a session they went to and I was like oh shoot I wish I would have known that like that is what I was super interested in.  
	So I would say take the time.  Review the program.  Whether you're a paper-pencil person, want to mark up your sheet or do something on the app which sessions you're going to go to.  
	Prepare and I think you'll have a better experience.  And if you can have a backup, too, because especially if you're running a little late getting to a room you might go to your first choice and find that it's actually full and that they are not letting more people in the room or maybe you really don't want to stand in the back so it's nice to have your first choice circled and also a backup plan in case that room is full.  
	And as far as expanding your -- getting out of your comfort zone, I would say do that two ways.  
	This is a field that is -- has a lot of strong opinions.  
	Among different people.  
	And this is a great opportunity to go and hear somebody who does have a different strong opinion than what you have.  
	So I would do at least one of those.  
	And then I would also mix it up in terms of topic.  
	So rather than going just to things you actually are already really good at, sometimes what ends up happening there is you sit there and you're -- you're nodding your head and you're nodding your head because you already know it all you're listening like great, you walk out of the room like gosh I could have given that presentation I'm not sure I learned anything new but if you go to something you don't do every day you don't know a lot about you probably will walk out with some new knowledge and of course learn, meet people, have a great time.  I would now like to turn it over to Dr. Arial from the American Academy of Pediatrics.  
	>> Hi everybody.  Thank you so much for having me as you mentioned I'm Arial I'm a developmental pediatrician from Boston University in Boston and I just realized I don't have the clicker.  It's right here.  Sorry.  
	And I have the privilege of speaking with you on behalf of the American Academy of Pediatrics or AAP to represent the medical home piece of EHDI as one of the Massachusetts Chapter Champions.  And I also want to say that I feel like I have the privilege of speaking as a person on this panel with the least experience.  And it's very humbling to come after everybody else on this panel.  So I hope that inspires some of the audience members what you can take away from EHDI and build your journey.  
	So according to the AAP which is an organization of about over 70,000 pediatrics in the U.S. and -- pediatricians in the U.S. and a partner of the EHDI program a medical home is an approach to providing comprehensive medical care that facilitates partnerships between patients, clinicians, medical staff and families and a medical home extends beyond the four walls of practice it includes specialty care educational services family supports and more.  
	What does this actually mean for parents of children -- parents of children who are Deaf and hard of hearing and how can the medical home support these families and children.  Basically why should the medical home be at EHDI and why should EHDI be in the medical home well children of all ages go to their primary care providers or PCPs in the beginning they go a lot.  
	Parents also look to PCPs for guidance as partners in decision making.  And finally, particularly for children who require subspecialty care in clinic in early intervention and in school and in the community PCPs are at the center of a wide web of providers and teams who may each be focusing on one aspect of a child's health yet the PCP can take a step back and help bring the focus back to the whole child and their family.  At the same time PCPs receive little formal training in caring for Deaf and hard-of-hearing children I recently gave a presentation to over 100 primary care providers in Massachusetts.  And when I started the presentation, I just asked who was familiar with 1-3-6 guidelines.  And not a single person raised their hands.  
	So we have a lot of work to do.  
	The providers for our children and families are unfamiliar with the guidelines for care and maybe have never encountered a Deaf and hard-of-hearing adult or child that they are aware of.  
	And typically in medical school a lot of providers or in clinical training are only exposed to the medical model of disability or difference which pathologizes differences and talks about and encourages the treatment, fixing, cure of any difference versus the social model of disability that looks to view difference in the context of the world in understanding accessibility versus disability.  
	So we understand the why.  Now about the how.  So how do we bring these evidence-based guidelines, interdisciplinary care and expertise and family and self-advocate experience that we learn about and get to enjoy here at EHDI into the medical home.  One way is through improving education.  Providing accessible, reasonable education that does not expect every pediatrician to be an expert in EHDI but rather to understand the basics of hearing screening, diagnosis and intervention.  
	Having high expectations for Deaf and hard-of-hearing children.  And monitoring language and development with a low threshold for referral for additional assessment or support.  
	Most importantly, making sure that pediatricians know where and who to turn for help when they have the baby in the clinic who didn't pass the hearing screen or a 2-year-old with a new onset hearing difference after exposure to an ototoxic medication in my experience when you give PCPs and medical home providers the materials and information, they understand the importance of early diagnosis and intervention.  And can then feel empowered to go through this process with their patients and families, even if it's the first time.  
	And so what you'll see up on this slide is the website where you can find all of your American Academy of Pediatrics Chapter Champions for your state so if you go to that QR code you can just click on the link for your state and find the contact information.  
	Part of how I got involved and I highly encourage everybody here to do the same, I can guarantee you they are all really nice, wonderful people, who are excited to get your email.  And so if it's the first time that you're meeting with someone, definitely reach out to them.  
	As far as educational materials, you don't have to do anything.  
	The AAP in collaboration with EHDI has actually created a number of materials which can be found on this website here.  
	And the AAP in collaboration with a bunch of really fantastic interdisciplinary stakeholders has put together these resources and guides as well as informational presentations and case-based clinical discussions to help pedestrians learn about -- pediatricians learn about EHDI and connect to their local EHDI resources.  
	Okay.  
	This is where I was supposed to say that you can find your Chapter Champions, sorry, everybody.  
	So in addition, the AAP facilitates the Chapter Champions which is a role for each stayed there's a pediatrician who is designated just to be a resource for your state in understanding and accessing information on how to support children not just in the general medical home but in that specific medical home in that state understanding its needs, its strengths and its resources.  
	So that QR code will bring you to that website.  And you can click on your state to find the contact information.  
	Okay.  
	So you might be asking yourself that's all great, what does this have to do with coming to EHDI.  All of these materials were created by partnerships as I mentioned across disciplines, families and self-advocates who connect in many ways through EHDI.  
	The sharing of ideas as you will see at this conference is also what makes these resources so powerful and up to date.  
	And there's always more work to do that we can only figure out if we work together and collaborate.  
	So how do we improve education?  Who or -- what or who might be missing from the table and from or materials?  How do we get the information into the right providers hands for example the providers who have a patient who just referred on their hearing screen who have never had a patient who referred on their hearing screen what makes EHDI so exciting is while we're sitting up there in Massachusetts trying to figure this out somebody in North Dakota may already have done that and we can share and collaborate, especially now in our digital and virtual worlds.  
	So my personal EHDI journey began in 2017 while I was still a very tired resident in pediatrics in Boston and as a former ASL and Deaf studies student I always knew I wanted to work with Deaf and hard-of-hearing children but I had never heard of EHDI I had never heard of 1-3-6 and I had no idea what I was going to do after residency thankfully my mentors dragged me along and I remember being very overwhelmed and very tired I came home and told my family oh, my goodness I found my people how do I do this for the rest of my life and I imagine many people in this room will have that experience, too.  
	Fast forward to 2020, after some hiccups withdrawing last minute from the conference in 2020, because I had just found out I was pregnant with my second child showing here is my first child watching diligently as we all did at our home computers across the country with our pets and children presenting and sharing our ideas and making connections for collaboration to pick up after the end of the pandemic.  
	And finally, last year when I got to present alongside my amazing Massachusetts EHDI colleagues, so I have to give a shoutout to in this presentation.  
	The project that we've been working on is a perfect example of what EHDI can do for you and the families that you work with.  
	So our project was the development and assessment and distribution of an online educational module on caring for Deaf and hard-of-hearing children in a medical home.  So with funding from the Massachusetts EHDI program, we created an interactive online module on the open pediatrics platform which is an open access online platform of peer reviewed pediatric-related content that's available internationally.  
	The module was developed with stakeholders across developmental pediatrics, primary care, neonatology, psychology, public health, audiology, speech-language pathology, early intervention, parent, family and Deaf advocate perspectives.  Many of whom I connected through the EHDI Conference.  
	After undergoing two rounds of formal anonymous peer review our final module, which is publicly available as of 8:30 on Friday night just in time for EHDI consists of 26 minutes of animated, captioned and ASL interpreted videos, 6 family and patient testimonial videos, screenshots of which are shown here to demonstrate the quality of our product.  
	And then if you would like to share the course, which we highly recommend, you can register for free for an open pediatrics account and pay for CME credit for various fields.  And also enroll in the course, which is free if you opt not to get CME credit.  There's an option at the end for anonymous feedback.  And we would greatly appreciate any feedback that you have, particularly from this expert audience as we continuously evaluate and expand and create additional modules as part of a complete course on caring for children with hearing differences.  
	So how can you make the most of EHDI?  Connect with the people from your state.  Connect with your field of practice.  Connect with other families in your local community.  I can remember sitting back to that stakeholder meeting in 2017 was where I met my co-Chapter Champion mentor and friend who brought me along to a dinner that night of all the AAP Chapter Champions and I remember thinking I was meeting my heroes in person and I know many of you will have that same experience when you meet colleagues within your fields.  
	Never hesitate to go up to the presenter or exchange contact information from colleagues.  I always recommend keeping a list of potential collaborators on your phone in any notes app.  I like to use Google Excel spreadsheets because you can keep a person's email, their name, where they are from and their contact information and the context in which you met them.  
	And you will thank yourself in the future when you have an idea and you want to reach out to a person who may have been just as excited about that idea as you.  
	Wander into that presentation on something that you've never encountered or thought about.  
	Most importantly, focus on the families, the self-advocates and the Deaf Community members.  One of the things that makes EHDI and particularly this conference so unique is the active involvement of families and self-advocates and members of the Deaf and hard-of-hearing community.  
	As an integral part of the conference.  And not just as an afterthought and that's something that's really, really unique coming from a clinical space.  That you might not get anywhere else.  
	And then start planning.  How are you going to bring back what you learned to your communities, colleagues and your own medical homes in your communities and the families that you connect with in your various roles?  
	So thank you.  Reach out if you need anything.  
	>> Okay.  Thanks to all of our presenters.  I think Arial summarized it very well when she said, oh, my gosh, I've found my people and I think that is one of the things that I will always take with me from the EHDI Conference.  What a great family of EHDI participants we have.  
	So I hope you feel some of those same feelings.  
	I'm honored to have been able to participate on this panel with people who are so deeply involved in serving families and children.  
	So we do have just a few minutes for questions.  
	If there are questions, I'll hand you a mic.  
	And if not, I'm looking, looking, looking.  
	Then go enjoy the reception.  
	Put in place all of those great suggestions you just had.  
	And welcome to the EHDI Conference.  We're looking forward to -- oops.  
	A question.  
	Those lights are wonderful.  
	>> Yeah, the question is, will you make the PowerPoints that were used today available to us?  
	>> Yes.  
	>> Great, thank you.  
	>> The PowerPoints will be available.  They are on the website.  
	It may take a day or two to get them all loaded we've had a couple of technical glitches but they will all be there.  
	And the people who were on the panel I'm sure would be happy to hang around here a few minutes if you want to talk individually with them.  Or you can take them with you to the reception, which is next door.  
	And continue the discussion there.  
	Any other questions?  
	Thanks for coming.  You're about to embark on a wonderful journey.  And we're so pleased to be able to go on that journey with you.  
	So enjoy the reception.  

(Session ended at 6:55 p.m. CDT)