Measuring Benchmarks and Quality Indicators for Early Intervention Dawn M. O’Brien, M.Ed. EI/ECSE Nannette C. Nicholson, Ph.D. CCC-A Judith E. Widen, Ph.D.

Measuring Benchmarks Measuring Benchmarks and Quality Indicators for and Quality Indicators for

Early InterventionEarly Intervention

Measuring Benchmarks Measuring Benchmarks and Quality Indicators for and Quality Indicators for

Early InterventionEarly InterventionDawn M. O’Brien, M.Ed. EI/ECSEDawn M. O’Brien, M.Ed. EI/ECSE

Nannette C. Nicholson, Ph.D. CCC-ANannette C. Nicholson, Ph.D. CCC-AJudith E. Widen, Ph.D. CCC-AJudith E. Widen, Ph.D. CCC-A

Introduction

Local

State

Federal

Kansas •105 Counties•37 Networks

–Leavenworth County Infant-Toddler Services: tiny-k program

Background• Performance Measures

– Principles– Benchmarks– Quality Indicators

• JCIH Position Statement

Focus• Joint Committee on Infant Hearing 2000

Position Statement– Principle 3 – Early Intervention

• Six Benchmarks• Ten Quality Indicators

– Principle 8 • Data collection

Benchmarks for Early Intervention

1. Enrolled prior to 6 months of age

2. Professional personnel & communication options

3. Use of amplification within one month of confirmation of hearing loss

Benchmarks for Early Intervention

4. Audiologic monitoring not to exceed three months

5. Language is developmentally appropriate

6. Family demonstrate self-advocacy

Matching Benchmarks & Quality Indicators

• Percentage of infants before 6 months of age

• Percentage…with professional personnel who are knowledgeable

1.Enrolled prior to 6 months of age

2. Professional personnel & communication options

Matching Benchmarks & Quality Indicators

3.Use of amplification within one month of confirmation

• Percentage of infants with who begin use of amplification within one month of confirmation of the hearing loss

Matching Benchmarks & Quality Indicators

4. Audiologic monitoring not to exceed three months

• Percentage … receive monitoring at intervals not to exceed 3 mo.

• Number of follow-up visits in the first year

Matching Benchmarks & Quality Indicators

5. Language is developmentally appropriate

• Percentage of language evaluations every 6-months

• Percentage of infant’s language equal to hearing peers

• Percentage of achieved outcomes on IFSP

Matching Benchmarks & Quality Indicators

6. Family demonstrates self-advocacy

• Percentage of families who refuse EI

• Percentage of families who participate in and express satisfaction with self-advocacy

Problem• Who is responsible for reporting data?• Is the information available?• If so, where is the information located?

Question?• Does our network collect the data

necessary to report information to the state on Benchmarks and Quality Indicators for Early Intervention?

Method• Subject Selection

– Criteria– Population

• Procedure – Matching Benchmarks and Quality

Indicators– Database Design– Retrospective Chart Review

Subject SelectionCriteria

• Birth to three • Enrolled in Early Intervention in

Leavenworth County after 1999• Hearing loss greater than 20 HL

dB bilaterally

Population• 260 (1999 – 2003) Part C Eligible

Infants and Toddlers– 5 children diagnosed with >20 dB

hearing loss sensorineural or conductive•4 actively followed by an

audiologist and early intervention

Matching Benchmarks & Quality Indicators

• Percentage of infants before 6 months of age

• Percentage…with professional personnel who are knowledgeable

1.Enrolled prior to 6 months of age

2.Professional personnel & communication options

CalculatingQuality Indicators

1. Percentage of infants with hearing loss who are enrolled … before 6 months of age a. # < 6 months/# HL in program

Database Design

1. Enrolled prior to 6 months of agea. Date of birthb. Date of enrollment (referral date)

RetrospectiveChart Review

• Intake Form • Individual Family Service Plans • Audiology reports• Speech language evaluation reports• Speech evaluation test forms• Progress notes• Anecdotal notes

Results1. Percent enrolled prior to 6 months of

age (60%)– Child 1 = 2 mo – Child 2 = 2 mo – Child 3 = 13 mo – Child 4 = 11.5 mo– Child 5 = 1 mo

Results2. Professional personnel &

communication options• Not included in this study

Results3. Percent use of amplification within one

month of confirmation (0%)• Child 1 = 3/01-6 mo +

Contraindication• Child 2 = 3/01 - no hearing aid fit date• Child 3 = no ABR date/hearing aid fit

date• Child 4 = 4/01 - no hearing aid fit date• Child 5 = Soundfield AC/ no hearing

aids

Results4. Percent of infants …audiologic

monitoring not to exceed three months (0%)

• Child 1 = 9/01, 12/01, 6/02, 10/02, 11/02

• Child 2 = no hearing aid fit date • Child 3 = no hearing aid fit date• Child 4 = no hearing aid fit date

Results4. Number of follow-up visits in the first

year– Child 1 = 2 Visits– Child 2 = no hearing aid fit date– Child 3 = no hearing aid fit date– Child 4 = no hearing aid fit date

Results5. Percent of children with language

evaluations every six months (0%)– Child 1 = 3/01, 10/01, 4/02– Child 2 = 3/01– Child 3 = 4/02, 12/02– Child 4 = 2/03

Results5. Percent of infants with language equal

to hearing peers (0%)– Unable to determine

Results5. Percent of achieved IFSP outcomes

(0%) • Child 1 = not met• Child 2 = not met• Child 3 = not recorded• Child 4 = not recorded

Results6. Family self-advocacy

– Refusal• Not included in study

– Express satisfaction with self advocacy• Not included in study

Conclusion• Depends on the communication

between the early intervention program and the audiologist

• Standard data collection methods should be established

The End

Database Design

1. Enrolled prior to 6 months of agea. Date of birthb. Date of enrollment (referral date)

Database Design2. Professional personnel &

communication options a. Information is not available in

chart

Database Design3. Use of amplification within one month

of confirmation

a. Date of ABRb. Documented medical

contraindication c. Date of medical clearance d. Documented family consente. Date of hearing aid fit

Database Design

4. Audiologic monitoring not to exceed three months

a. Date of hearing aid fitb. Date of each audiology contact

documentation in the child’s file

Database Design5. Language is developmentally

appropriatea. Date of birthb. Date of each language evaluation c. Corresponding developmental

leveld. Corresponding language agee. Achieved IFSP outcomes

Database Design

6. Family self-advocacya. Information is not available in

chart