PP903 - Creating Homebirth Community Partnerships to Address Loss to Follow-up for Newborn Hearing Screening

Abstract:
Children born within the homebirth community in Nebraska face risks for not receiving newborn hearing screening due to unique social and political barriers. These barriers can hinder access to hearing healthcare, potentially leading to developmental delays in children with hearing loss. Two initiatives are discussed: (1) The establishment of a partnership between a state Early Hearing Detection and Intervention (EHDI) program and a hospital for newborn hearing screening follow-up. (2) The formation of a Community Advisory Board, (doulas, midwives, and homebirth parents), to support development of a community-driven action plan for improving access to newborn hearing screening and follow-up.

Summary:
Funded by a community-engaged research planning grant (NIGMS) to develop partnerships between healthcare and community organizations, staff from the Nebraska Early Hearing Detection and Intervention program and the Audiology clinic and Research departments at Boys Town National Research Hospital (BTNRH) collaborated with the intent of decreasing newborn hearing screening loss to follow-up. The CDC Partnership Evaluation guide (Jernigan et al., 2008) was utilized to define the roles of each person and organization within the partnership, cooperatively create a partnership evaluation, and create a logic model to define the context within which the partnership will be working.

The first goal of the partnership was to identify a community at-risk for loss to follow-up to newborn hearing screening. A de-identified dataset of the hearing screening status and demographic characteristics (insurance type, language, hospital or homebirth, race, ethnicity, and maternal level of education) of the children who were born in Nebraska from 2017-2022 was used to determine the number and percent of families with different characteristics who were lost to follow-up. Analysis indicated that the community most at-risk for being lost to follow up was families who had a homebirth. Three out of five children born at home (61.3%, n=255/416) were lost to follow-up compared to 0.2% of the hospital-based births.

Children born within the homebirth community in Nebraska are at-risk for not receiving a newborn screening. Homebirth families face unique barriers to accessing hearing healthcare and subsequent intervention, which could place children who have hearing loss at risk for developmental delays. Other states have successfully implemented training plans to support midwives in completing newborn hearing screening, reducing loss to follow-up for homebirth babies (Palmer et al., 2019). However, Nebraska’s social and political environments challenge homebirth providers and parents in accessing necessary support to access newborn hearing screening.

Brief Summary of Clinical Takeaways:
The partnership invited members of the Nebraska homebirth community (doulas, midwives, parents) to join a Community Advisory Board (CAB) to inform and address obstacles to obtaining timely newborn hearing screening. Invitations were shared on homebirth social media groups and through personal email with a list of local doulas. Eight members with varying levels of experience with newborn hearing screening and homebirths were enrolled and participated in the two CAB meetings.

The first meeting, in March 2024, centered around completing a needs assessment (themes and questions from Nickbakht et al., 2022). The needs assessment addressed four topic areas as they relate to obtaining a newborn hearing screening: informational support, information provision, professional support, and financial support.

The second CAB meeting, in April 2024, focused on developing a community-based action plan based on the themes and topics identified in the needs assessment; evaluating feasibility, time frame, and resources. Thirty specific actions were identified. At the completion of the meeting, partnership and CAB evaluations were completed by all members.

Current implementation has prioritized short-term, low-cost action items such as updating current brochures with information for homebirth families. Long-term high-cost action items such as training trusted homebirth providers in newborn hearing screening are pending a second wave of funding.