Better Late Than Never? Maternal Biopsychosocial Predictors of Late Follow-up from New Jersey's Early Hearing Detection and Intervention Program

Background and Purpose: Early hearing detection and intervention (EHDI) programs are public health initiatives designed to identify congenital hearing loss. These universal programs attempt to screen all children at birth to identify, diagnose, and treat those with hearing loss in a timely manner. Timely follow-up is necessary in order to mitigate potentially negative consequences of hearing loss and help insure children reach developmental milestones including cognitive and language development and social skills.

While the need for timely follow-up has been well documented, most follow-up research has focused on babies who do not continue recommended follow-up and are lost to follow-up (LTF). Professional organizations such as the Centers for Disease Control and Prevention (CDC) often focus on those babies who are LTF as this has been a persistent problem since EHDI programs were first established.

Another group that warrants additional study are babies who follow-up, but whose follow-up is outside the timelines recommended by public health organizations. While these babies may ultimately receive complete diagnostic exams and/or treatment, they are at risk for impaired or delayed development. Therefore, the current research seeks to better understand the factors that contribute to late follow-up at the point of diagnosis.

Methods: All babies born between June 2015 and June 2017 in New Jersey were considered for inclusion in the study. The final analytic sample consisted of 717 babies who, following the state’s EHDI protocol, needed diagnostic hearing evaluations and received them. All data came from the state’s Department of Health and included birth information for the baby and demographic and health information about the mother. Logistic regression was utilized to identify a constellation of factors predictive of late diagnostic exams while controlling for maternal age and education, known predictors of timely follow-up.

Results: In an initial bivariate analysis, significant predictors of late follow-up included post-natal depression, not having insurance, participation in WIC, not being married, being Hispanic, and the baby having a previous yet incomplete diagnostic evaluation. The best-fitting logistic regression model indicated that, controlling for maternal age and education, mothers with indicators of post-natal depression were 89% more likely to follow-up late (OR=1.89; p=0.04). Mothers with no insurance were 104% more likely to be late (OR=2.04; p<0.01), and mothers enrolled in WIC were 111% more likely to be late (OR=2.11; p<0.01). Finally, babies who had a previous incomplete diagnostic exam were 432% more likely to be late (OR=5.32; p<0.01). Post-estimation goodness of fit statistics indicated that the data fit the model well.

Conclusions and Implications: This research expands upon previous study examining noncompliance with recommended hearing tests for newborns. In previous research, WIC participation was predictive of follow-up, and this study indicates that that follow-up is more likely to be late. Additionally, post-natal depression has been predictive of LTF at the point of rescreening. This research finds that, if mothers do follow-up at the point of diagnosis, it is typically late. These findings help identify a profile of mothers who need additional intervention in order to encourage compliance with recommended health care.