Background

Wisconsin Sound Beginnings and WIC Collaboration:Successfully Reducing Loss-to-Follow-Up

Rebecca Martin, MPH and Elizabeth Seeliger, AuD

Early Hearing Detection and Intervention Conference, April 14-16, 2013● Glendale, AZ

Results: between December 2011-December 2012, WSB placed 129 WIC Alerts (data run 1/16/2013)

Lessons Learned

• In July, 2011, Wisconsin Sound Beginnings (WSB) signed a Memorandum of Agreement with WIC (Special Supplemental Nutrition Program for Women, Infants and Children), allowing WSB access to WIC’s statewide database.

• There are 92 WIC sites serving rural, urban and tribal areas throughout Wisconsin’s 72 counties. • In order to test the effectiveness of active versus passive involvement of WIC clinics, WSB

divided the WIC sites into follow-up protocols A and B: • 78 WIC-A sites• 14 WIC-B sites: 3 urban City of Milwaukee and 11 rural Great Lakes Inter-Tribal Council

(GLITC) sites • In December 2012, WSB changed 5 WIC-A protocol sites to WIC-B protocol.

• As part of WSB’s 3-Step-Follow-Up protocol, WSB places an alert in the WIC file for any WIC participant baby who did not pass their inpatient screen and has not received follow-up. WSB places alerts only after confirming the baby does not have follow-up scheduled or has not attended scheduled appointments. WSB removes the alert after the baby receives follow-up. WSB began placing, tracking and removing alerts in December 2011.

• WIC-A sites give alerted families a letter that WSB provided in English, Spanish and Hmong.• WIC-B sites have WIC staff contact a WSB Regional Outreach Specialist (ROS) to coordinate an

outpatient screen. The ROS can screen the baby in the home, at a WIC appointment or at another community location.

• The goal is to place the alert in time for the WIC certification appointment (when baby is 44 days old) so the ROS could screen baby at that appointment (monthly WIC check pick-ups do not require baby’s presence).

• WSB tracks alerts and their outcomes to evaluate the alert protocols and document any emerging trends.

• A family’s WIC status is never included in child-specific documentation in the WSB data system as it is an indicator of socio-economic status.

WIC-A HEARING SCREENING ALERT: Baby did not pass newborn hearing screening and needs follow-up. Give family Hearing Screening Follow-up Letter and review it when you interact w/family.

WIC-B HEARING SCREENING ALERT: Baby did not pass newborn hearing screening and needs follow-up. Wisconsin Sound Beginnings can conduct a hearing screen with baby's next WIC appointment. Call Susan at 414-555-1234 to coordinate care.

WIC-A:102 alerts69 cases successfully completed67% success rate16 open/active WIC-A cases

WIC-B:27 alerts16 cases successfully completed59% success rate10 open/active WIC-B cases

ACKNOWLEDGEMENTS• This project is the result of collaboration between Wisconsin Sound Beginnings and Wisconsin’s Special Supplemental Nutrition Program for Women, Infants and Children (WIC). • This poster was funded in part by grants from the Maternal Child Health Bureau of the Health Resources and Services Administration, U.S. Department of Health and Human Services..

• Number of WIC cases that had an in-home or in-community screen by WSB staff: 22

• Average length of time a WIC alert is in place before child receives follow-up: 53 days

• Average length of time between DOB and alert placement (for babies timed out at 30 days of age): 44.6 days

Areas with the highest number of WIC alerts:

• Coordinating hearing screenings with the 44-day WIC certification appointment has been challenging.

• WIC clinics do not always look at the client’s case in their data system until the day of the appointment, making coordinating a screen difficult to schedule ahead of time.

• WSB places WIC alerts only after confirming the baby does not have follow-up scheduled or has not attended scheduled follow-up appointments.

• Instead, a trend emerged that WIC-B site staff called WSB with the family at their WIC appointment to set up in-home/community screens or help family access follow-up care. In urban Milwaukee, this has resulted in more in-home screens. In the northwestern rural/tribal region, this has resulted in more families accessing teleaudiology services. WIC involvement still played an important role in follow-up.

• WSB identified five sites with high rates of WIC alerts, received state and local approval to change these sites from A to B protocol and in December 2012 began placing WIC-B alerts in these sites.

• The WIC data system provides important information on a family’s situation that WSB would not normally be able to access, which has improved our follow-up efforts (e.g., changes in child custody, moves, updated contact information).

• WSB will continue evaluating WIC-B protocol by changing WIC-A sites to WIC-B sites to increase the number of cases in these sites who will fit the WIC-B protocol.

• WSB is currently unable to directly measure if WIC-A protocol families receive the letter. Some clinics voluntarily tell us they gave the letter. WSB will change the WIC-A protocol to request that WIC document that they gave the family the letter in the WIC alert.

• In specific cases, WSB used the alerts to communicate additional information with WIC staff (e.g., that a child referred on an in-home screen and needed audiological follow-up). WSB will investigate the effectiveness of using alerts to ask for WIC assistance in getting families to additional follow-up services.

• WIC collaboration has helped Wisconsin reduce its Loss-to-Follow-Up rate. WSB will continue to utilize and evaluate effective ways to measure the WIC alerts’ impact.

• WSB will explore additional collaborative pathways with WIC to reach Wisconsin families at risk for Loss-to-Follow-Up.

Future Directions