Enhancing communications among agencies session 2
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Enhancing Communications Among Agencies Session 2. Kris Grbac, M.A., CCC-A. Missouri State University Springfield, Missouri Catherine Harbison, B.S.N., M.A. Missouri Department of Health and Senior Services Jefferson City, Missouri. Faculty Disclosure Information

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Enhancing Communications Among Agencies Session 2

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Enhancing Communications Among AgenciesSession 2

Kris Grbac, M.A., CCC-A.

Missouri State University

Springfield, Missouri

Catherine Harbison, B.S.N., M.A.

Missouri Department of Health and Senior Services

Jefferson City, Missouri

Faculty Disclosure Information

In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation.

This presentation will (not) include discussion of pharmaceuticals or devices that have not been approved by the FDA or if you will be discussing unapproved or “off-label” uses of pharmaceuticals or devices.


  • Project: Round Table Discussions on Intervention

    • Meetings held throughout the state.

  • Topic: Intervention for newborns identified with hearing loss.

    • Original purpose was to collect information on the process of getting newborns with hearing loss into intervention. Additional purposes developed over time.


Department of Health and Senior Services

Department of Elementary and Secondary Education




  • Characteristics of Missouri’s Part C Program

  • Part C does not directly provide any service

  • Service coordination and development of IFSP provided by contracted agencies known as “SPOE” (single point of entry)

  • Service provided by independent providers who have enrolled as Part C providers

Variables That Contributed to the Formation of Roundtable Meetings

  • Inability to receive personally identifiable information (due to FERPA) from DESE re: enrollment in Part C, hearing aids, etc.

  • No reports from agencies (no requirement to do so) on intervention data elements and unusual occurrences, such as baby who passed birth screening but later was diagnosed

  • No relationship between DHSS and SPOEs

  • Unknown intervention resources in rural communities

  • Families in contact with 4 different entities (audiologist, interventionist, DHSS staff and SPOE)

  • Many mild, conductive and unilateral hearing loss diagnoses (40%)

Procedure: Planning and Completing the Meetings

  • Invited audiologists, interventionists, SPOE staff and DHSS staff

  • Solicited participants by email and phone calls

  • Planned first meetings for our biggest urban centers and surrounding rural areas

  • Scheduled meetings for 3 to 4 hours

  • Provided free lunch

Procedure: Planning and Completing the Meetings

  • Advertised meetings as “true round table discussions” – no formal agenda

  • Provided participants with a list of topics that could be discussed and invited them to contribute additional topics






Results: Attendance

  • Good Attendance

    • 100% of the invited audiologists attended

    • 100% of the invited interventionists attended

    • 91% of the invited SPOE staff attended

Results: Topics

  • Referral process to Part C

  • Mild, conductive and unilateral hearing loss

  • Communication between agencies

  • Consent to release information from families

  • Availability of intervention providers

  • Reporting procedures (from audiologists to DHSS)

  • Payment for hearing aids

Results: What We Learned

  • Missouri’s rural areas have very different concerns than the urban areas

  • Newborns with bilateral moderate (or worse) sensorineural hearing loss in urban areas are receiving appropriate intervention

  • Intervention to newborns in rural areas is patchy

  • There is no uniform procedure or belief among audiologists, interventionists and SPOE staff regarding appropriate intervention for newborns with mild, conductive and unilateral hearing loss

  • Some SPOE agencies were very confident in their ability to coordinate services for newborns with hearing loss, others admitted that they did not know what to do unless it was written in report

Results: DHSS Actions in Response to Concerns

  • Developed “Guideline for Reporting” for audiologists in response to their concern about knowing when to report

  • Developed “Border Babies” document in response to audiologists concerns about how to report for babies who live or receive services out of state

  • Revised a resource document on agencies and individuals who provide services to newborns with hearing loss in response to the concern that the document was out-of-date

  • Worked with DESE to develop training materials for SPOE Staff

Additional Benefits

  • Opportunity to meet people previously only known by phone and mail, form relationships and gain insight into all aspects of the EHDI process in Missouri

  • Establishment of DHSS as lead agency

  • Generation of ideas for enhancing program.

  • Illumination of program areas that need work.

For more information:

  • http://www.dhss.state.mo.us/NewbornHearing/

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