Prevention and Social Work: The Case of Newborn Hearing Loss

BACKGROUND AND PURPOSE:  Children’s hearing is a public health concern as poor hearing can result in long-term deficits in cognitive development, expressive and receptive language, intelligibility, social adjustment and behavior (American Speech-Language-Hearing Association, 2008; Centers for Disease Control (CDC), 2012).  Universial newborn hearing screening (UNHS) is the first step in early hearing loss detection and have been found to be effective; children with hearing loss who have been screened shortly after birth have been diagnosed and treated earlier than those not participating in these programs (Nelson, Bougatsos, & Nygren, 2008).  Social work services for families that need support in this process are limited and underfunded, and there is no universally accepted social service protocol for these families (American Speech-Language-Hearing Association, 2008; Young, Tattersall, McCracken, & Bamford, 2004). 

The purpose of the study was to develop a profile of families most at risk for not returning for recommended treatment in order to determine who may be best suited for social work intervention.

METHODS:  UNHS records from a large suburban health system located in a northeastern state were analyzed. Only records of infants born and screened at system hospitals were included. 

Binary logistic regression was utilized to examine the influence of six predictor variables for infants being fit for a hearing aid or lost-to-follow-up based upon preliminary chi-square analysis. Predictors included:  nursery type, insurance type, distance of the follow-up facility from infant’s home, type of hearing loss, severity of loss, and laterality of loss.

RESULTS:  Hearing aids were fit on 107 of the 192 hearing aid candidates (56%) who completed follow-up, while 85 infants (44%) were lost-to-follow-up after diagnosis and before hearing aids were fit.  

Results from the logistic regression indicated that the likelihood of being fit with hearing aids decreased by 94% (p=0 .01) when unilateral hearing loss was present. The presence of a conductive hearing loss decreased the likelihood of being fit by 81% (p=0.01). Infants with Medicaid were 53% less likely to be fit with hearing aids (p=0.05).  Finally, families who lived more than 25 miles from the hospital had a 57% (p=0.04) decrease in the likelihood of being fit.

CONCLUSION AND IMPLICATIONS:  These findings illustrate the need for a connection between prevention services and social work intervention.  Loss-to-follow up is particularly problematic in children who have unilateral and/or conductive losses, and there is room for social work intervention in working with these families.  In order to prepare social workers to be effective with this population, emphasis should be placed on educating social workers about the needs of families that face having a child with hearing loss.    

In this study, it is possible that children with unilateral and/or conductive losses may have been given different advice from health care professionals than those with bilateral or sensorineural losses (“National workshop on mild and unilateral hearing loss:  Workshop proceedings,” 2005; Spivak, Sokol, Auerbach, & Gershkovich, 2009).  Attention should be paid to providing all professionals, and especially social workers, with information so they can guide families in care for their children.