Melanie Besculides

Evaluation of the Universal Newborn Hearing Screening and Intervention Program

During the last 20 years, the number of infants evaluated for permanent hearing loss at birth has increased dramatically with universal newborn hearing screening and intervention (UNHSI) programs operating in all US states and many territories. One of the most urgent challenges of UNHSI programs involves loss to follow-up among families whose infants screen positive for hearing loss. We surveyed 55 state and territorial UNHSI programs and conducted site visits with 8 state programs to evaluate progress in reaching program goals and to identify barriers to successful follow-up. We conclude that programs have made great strides in screening infants for hearing loss, but barriers to linking families of infants who do not pass the screening to further follow-up remain. We identified 4 areas in which there were barriers to follow-up (lack of service-system capacity, lack of provider knowledge, challenges to families in obtaining services, and information gaps), as well as successful strategies used by some states to address barriers within each of these areas. We also identified 5 key areas for future program improvements: (1) improving data systems to support surveillance and follow-up activities; (2) ensuring that all infants have a medical home; (3) building capacity beyond identified providers; (4) developing family support services; and (5) promoting the importance of early detection.

Best Practices in Implementing Lifestyle Interventions in the WISEWOMAN Program: Adaptable Strategies for Public Health Programs

Purpose. Describe best practices for implementing a variety of lifestyle interventions targeting cardiovascular disease risk factors. Approach. A mixed-methods approach was used to collect and analyze data. The study was guided by the RE-AIM framework. Setting. Selected Well-Integrated Screening and Intervention for Women Across the Nation (WISEWOMAN) projects funded by the Centers for Disease Control and Prevention. Participants. Five of the 15 currently operating WISEWOMAN projects were selected for study. Selection was based on availability of quantitative performance data, which were used to identify two high-performing and one low-performing sites within each project. Method. Qualitative data collection included a review of program materials; telephone interviews with federal, project, and local staff and site visits. Site visits involved interviews with staff, observations of the lifestyle intervention, and discussions with focus groups of participants. Analysis involved writing site reports, developing theme tables, identifying practices of interest, and applying an algorithm to identify best practices. Results. Eighty-seven best practices were identified. We present a subset of 31 practices applicable to other public health programs and for which differences in how high- and low-performing sites used the practices were identified. Discussion. Many of the best practices identified are applicable to broader audiences. Practitioners interested in strategies to recruit, engage, and retain participants and to facilitate behavior change can learn from these practices.