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About Early Hearing Detection and Intervention (EHDI) Programs

Early Identification and Referral

About Early Hearing Detection and Intervention (EHDI) Programs

Early Identification and Referral

This page was last updated on Nov 27, 2013 at 8:48 pm

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Know the System

Efforts to identify children with hearing loss as early as possible began in the mid 1960s with public information campaigns and the development of techniques for testing children five to twelve months of age. In 1988, however, the Commission on Education of the Deaf reported that two and a half years was the average age of identification for profoundly deaf children in the United States. [1]  The US Department of Education and the Bureau of Maternal and Child Health formed an advisory group to explore the feasibility of developing guidelines for early identification. They recommended that the federal government fund demonstration projects to expand and document early identification efforts [2] and Surgeon General C. Everett Koop issued a challenge that by the year 2000, 90% of children with significant hearing loss be identified by twelve months of age. [3]  The Joint Committee on Infant Hearing (JCIH) laid the foundation for Universal Newborn Hearing Screening with a Position Statement in 1990 recommending that high-risk infants be screened prior to their discharge from the hospital and no later than three months after their birth. [4]  Further expansion of this important work evolved into the Early Hearing Detection and Intervention (EHDI) network whose mission is for every state and territory to have a complete tracking and surveillance system to ensure that infants with hearing loss are identified early and appropriate intervention services are initiated to facilitate the development of language, cognitive and social skills. The EHDI network has adopted the following goals: [5]

1.  Screening all newborns for hearing loss before one month of age, preferably before hospital discharge.

2.  Diagnostic audiologic evaluation before three months of age for all infants who screen positive.

3.  Appropriate intervention services for all infants identified with a hearing loss before six months of age.

4.  Identification of all infants and children with late onset, progressive or acquired hearing loss as early as possible.

5.  All infants with hearing loss will have a medical home.

6.  Minimize loss to follow-up through a complete tracking and surveillance system in every state.

7.  A comprehensive system in every state to monitor and evaluate progress toward EHDI Goals and Objectives.

In addition, EHDI programs strive toward a system that provides: [6]

  • A simplified, single point of entry into an intervention program, appropriate to children with hearing loss, that is family centered with infant and family rights and privacy guaranteed through informed choice, shared decision making, and parental consent
  • Families with access to information about all intervention and treatment options and counseling regarding hearing loss
  • The child and family with immediate access to high-quality technology, including hearing aids, cochlear implants and other assistive devices when appropriate
  • Continued assessment of communication development by appropriate providers and offers interdisciplinary intervention programs provided by professionals knowledgeable about childhood hearing loss
  • Intervention that recognizes and builds on strengths, informed choices, traditions and cultural beliefs of the families


Identify Potential Collaboration Opportunities

Since EHDI programs are focused solely on identifying infants with hearing loss it may seem that opportunities for collaboration are less evident than they may be for other systems serving infants and toddlers. However, if children identified with hearing loss are not being screened or tested for visions loss is an issue in your state, then the EHDI program presents as a very viable partner.  Raising awareness and knowledge about etiologies that put children at risk for combined vision and hearing loss as well as development connections between vision and hearing may encourage EHDI program personnel to provide information or referral information to families whose children may qualify as deaf-blind.

It is also interesting to note the parallels that exist between the goals and principles guiding EHDI activities and what state and multi-state deaf-blind projects strive for in identifying and providing services to children with deaf-blindness. Sharing goals, information, data, strategies, resources and lessons learned is likely to benefit both systems. As in any identification or referral effort it is important that technical assistance and related materials be tailored to match the recipient and the purpose. EHDI programs typically operate within the medical community rather than the educational community, which must be considered. Input from families and medical staff familiar with these systems may be valuable in developing TA materials and training.



[1] Commission on Education of the Deaf. Toward Equality: Education of the Deaf. Washington, DC: U.S. Government Printing Office, 1988.

[2] Advisory Group on the Early Identification of Children with Hearing Impairments. Minutes of the Bureau of Maternal and Child Health/Office of Special Education and Rehabilitative Services Advisory Group on the Early Identification of Children with Hearing Impairments. Washington, DC: Bureau of Maternal and Child Health. 19

[3] Mauk G.W., Behrens T.R. Historical, political, and technological context associated with early identification of hearing loss. Seminars in Hearing, 1993; 14: 1-17.

[4] Joint Committee on Infant Hearing. 1990 position statement. American Speech/Language Hearing Associateion, 1991; 33(Suppl. 5): 3-6.

[5] From the Joint Committee on Infant Hearing, 2007

[6] Principles and Guidelines for Early Hearing Detection and Intervention Programs. Retrieved 4/16/2012 from http://www.cdc.gov/ncbddd/hearingloss/recommendations.html     


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