Maternal Infant Health Program (MIHP)

Community of Practice Webinar

November 30, 2017

Welcome and Introductions

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Maternal-Infant Health Program Update

Early Hearing Detection

and Intervention (EHDI)

Program

November 2017

National EHDI GoalsThe 1/3/6 Goals for EHDI include:

"1" - All infants are screened for hearing loss no later

than 1 month* of age, preferably before hospital

discharge,

"3" - All infants who do not pass the screening will

have a diagnostic hearing evaluation no later than 3

months of age, and

"6" - All infants with a hearing loss are enrolled in

early intervention services no later than 6 months of

age.

* Rescreens

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It’s a Girl!

Full-term: 8# 8oz, 21 inches.

Hearing Screen tested at 12 hours, baby did not pass in both ears.

Parents given EHDI brochure and information on where to go next!

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Goal 1: Hearing Screen

no later than 1 month of age

Birth

Year< 1 Month 1-3 Months > 3 Months

Age

Unknown

2011 106,983 96% 2.5% 1.1% 0.3%

2012 106,118 96% 2.5% 1.2% 0.2%

2013 107,074 97% 2.5% 0.9% 0.02%

2014 107,928 97% 2.6% 0.8% 0.02%

2015 106,970 97% 2.7% 0.8% >.001%

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Update on Baby Sophia Parents took Sophia to local audiology clinic for a rescreen no later than 1

month of age.

Didn’t pass repeat test in both ears.

Family immediately scheduled a diagnostic evaluation within 3 months of age.

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Diagnostic Evaluation• Gives specific information about hearing status, not just pass/refer.

• Should be done by an audiologist experienced with working with infants.

• Should be a battery of tests: Auditory Brainstem Response, Otoacoustic

Emissions, and Tympanograms.

• Best practice facilities have to work hard to be recognized as best practice

facilities.

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Goal 2: Diagnostic test

no later than 3 months of age

Birth Year

# Babies

with hearing

loss

< 3 Months 3-6 Months > 6 Months

2011 166 51.8% 29.5% 18.7%

2012 162 54.3% 22.8% 22.8%

2013 156 55.8% 22.4% 21.8%

2014 173 58.9% 22.5% 18.5%

2015 164 50.0% 30.0% 20.0%

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Baby Sophia Pediatric Audiologist completes diagnostic testing and

finds a permanent hearing loss.

94% of babies with hearing loss have two parents with

typical hearing.

What is next for family?

▪ Early On

▪ Otolaryngology

▪ Genetics

▪ Ophthalmology

▪ Parent Support, Michigan Hands & Voices GBYS

▪ Children’s Special Health Care Services

▪ Audiologist that works with pediatric hearing aids

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Goal 3: Intervention

no later than 6 months of age

Birth Year < 6 Months 6-12 Months

2011 41.3% 15.9%

2012 62.5% 15.6%

2013 31.4% 13.2%

2014 23.9% 19.6%

2015 30.5% 22%

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Baby Boy Josh Born in August

Failed one ear

Family not given material and not told where to go

Screener told them equipment wasn’t working or it was

just fluid in the ear

Family decided to wait to go back

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Loss to Follow-up

Birth

YearReferred Michigan LTF/D Wayne County

2011 1557 822 53% 524 64%

2012 1173 569 49% 244 43%

2013 1182 491 42% 187 38%

2014 1103 489 44% 154 35%

2015 1267 556 44% 154 29%

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Loss to Follow-up

556 (44%)

Parents contacted but unresponsive: 247

Unable to Contact: 293

Unknown: 16

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EHDI Follow-Up Families continue to be contacted for all infants not passing the

screening

Initiated texting families for follow-up

Pediatric audiology facilities: appropriate testing versus what is closer

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How can MIHP providers help? Review babies on MCIR to verify passing hearing

screen.

For babies that do not pass the hearing screen, help

coordinate appropriate follow-up testing.

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How can I view hearing results? Log on to MCIR, go to the Add/Find feature, then go to

find the Hearing (EHDI) tab. Click on the Hearing (EHDI)

tab to view results for each child born 2004 and after.

If a tab is not present, hearing screen results for this child

have not yet been linked to MCIR or the baby may not

have been born in Michigan.

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Where is the EHDI tab? Pull up individual baby, in middle of page, you will be

able to view multiple tabs.

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Hearing Results Click on EHDI tab, will display screening results at top

and diagnostic test results below.

▪ Includes date entered, date screened, test method,

and results for each ear.

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What should I do next?

• Click on the Follow-up Detailed Information link to

learn about appropriate next steps for babies that

need follow-up. One of these babies could be in

enrolled in MIHP.

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Hearing Screen ResultsScreen Results

ACTION

Pass

▪ Monitor speech-language development.

▪ Review risk factors for late-onset hearing loss (www.jcih.org) and ensure at least one diagnostic

evaluation is completed before 3rd birthday.

Incomplete

▪ Hearing screen needs to be completed no later than one month of age.

▪ For NICU graduates, it is recommended to have an automated auditory brainstem response (A-

ABR) screen.

▪ If incomplete screen is due to parent refusal encourage family to have hearing tested.

FAIL

▪ If this is an initial failed screen then a hearing re-screen needs to be completed no later than one

month of age.

▪ If this is a failed re-screen then immediately send child for a diagnostic evaluation by a

pediatric audiologist. For pediatric audiologists in your area, please call 517-335-8878.

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Diagnostic ResultsWithin Normal

Limits

▪ Monitor speech and language development milestones.

▪ A child may be at risk for late-onset hearing loss (www.jcih.org).

Undetermined and

Conductive

(Transient)

▪ Further diagnostic testing needs to be completed immediately by a pediatric audiologist.

For pediatric audiologists in your area, please call 517-335-8878.

▪ Do not assume it is only middle ear effusion.

Sensorineural/

Auditory Neuropathy/

Mixed/

Conductive

(permanent)

▪ Contact Early On (1-800-Early On) to initiate intervention.

▪ Refer to otolaryngologist to determine etiology of hearing loss and recommended

treatment. Other referrals may include: ophthalmology, genetics,

developmental pediatrics, neurology, cardiology, and nephrology if appropriate.

▪ Ensure ongoing pediatric audiology services.

▪ Offer parent support for families through referral to the Guide By Your Side parent

support program. Call 517-335-8955 for more information on this program.

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Facts and Recommendations

1. AUDIOLOGICAL SERVICES (Don’t wait to refer!)

▪ Critical Screen Protocol: Do not continue to re-screen. If baby has failed two screens, refer directly to a pediatric audiologist to

perform diagnostic testing. It is difficult to rule out hearing loss without objective, frequency specific testing. A baby with a sloping

hearing loss will respond to a door slam or hands clapping, but may not hear a single consonant sound.

▪ Do not wait 3-6 months to do a repeat hearing screen. Even if child has otitis media do not wait this long to re-screen.

▪ The easiest and most accurate hearing testing is done when babies are in natural sleep. Early evaluations reduce the need for

sedated procedures later.

▪ Otitis media and middle ear effusion have a greater impact on screening measures than diagnostic evaluations. A full diagnostic

battery will identify permanent hearing loss even in the presence of middle ear effusion.

▪ Only 50% of babies with congenital hearing loss have an identifiable risk indicator at the time of birth. All babies failing a hearing

screen should be retested!

▪ Early identification and intervention of hearing loss has been proven to prevent delays in speech and language development.

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Late ID of Hearing Loss Late identification of hearing loss or lack of early intervention services can

negatively impact speech and language development, academic achievement

and social-emotional development.

The most critical time for stimulating the hearing centers in the brain is during

the first few months of life.

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Thirty Million Words (TMW)• Child language development research demonstrates some

children in a lower socioeconomic (SES) class hear about

30 million fewer words by age 4 than their counterparts.

• TMW develops and disseminates evidence-based, parent-

directed programs that encourage parents to harness the

power of language to build their children’s brains and shape

their futures.

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• Framework based on brain science with

“three t’s: tune in, talk more and take

turns.

• Tune in by paying attention to what your child is

communicating to you. This includes responding

to babies coos and cries with spoken language.

Get down on your child’s level. Maintain

comfortable eye contact. Show your child you

are interested in what they are saying.

Thirty Million Words (TMW)

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Talk more with your child using descriptive

words to build their vocabulary. Think of

yourself like a sportscaster, narrating your

child’s day. These don’t need to be exciting

times, necessarily, but just adding words to the

normal daily routines. “OK, it’s time to go

grocery shopping. Let’s find our shoes. Your

shoes are pink! My shoes are black.” And so

on. Add “big” words to your speech. “You saw

that big tree! It is humongous!”

Thirty Million Words (TMW)

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Thirty Million Words (TMW)Take turns by encouraging your child to

respond to your words and actions. Think of

a conversation with your child like playing a

game of catch. You want the ball to go back

and forth. Support your child engaging in the

conversation. Ask open-ended questions

instead of questions that have a yes or no

answer. Reflect back to your child what you

hear them saying. “It sounds like recess was

really fun today! Tell me more about the

game you played.”

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Thirty Million Words (TMW)• Website and newsletter for more information.

• You tube

https://www.youtube.com/watch?v=IOFnRoUiO6Y

• http://thirtymillionwords.org/

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Cytomegalovirus (CMV) Information

• Cytomegalovirus (CMV)- leading non-genetic cause

of hearing loss, causing 20% of childhood deafness

among other disabilities, such as blindness and

developmental delays.

▪ CMV- Common and preventable

▪ Resources

▪ CMV brochures (EHDI)

▪ www.NationalCMV.org

▪ www.cdc/gov/cmv/index.html

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Cytomegalovirus (CMV) Common

CMV is a member of the

herpes family of viruses.

Impacts 1 in 150 babies

annually.

40% of infected women can

pass the virus to their baby.

Up to 70% of healthy children

ages one to three are exposed

to CMV and maybe

asymptomatic carriers.

Preventable

CMV can be prevented by

avoiding contact with saliva

when kissing a child.

Do not share food, utensils,

drinks, toothbrushes.

Wash your hands after wiping a

child’s nose/mouth and after

changing diapers.

Day care providers-wear gloves

to change diapers.

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Contact information

EHDI Follow-up Consultant

Michelle Garcia, Au.D., CCC-A

(517) 335-8878 or garciam@michigan.gov

EHDI Program Coordinator

Debra Behringer, RN, MSN

(517) 373-8601 or behringerd@Michigan.gov

www.michigan.gov/ehdi

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BreastfeedingExclusivity versus Duration

Marji Cyrul, MPH, RD, CLS

MDHHS State Breastfeeding Coordinator

November 30, 2017

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Discharge summary change

• November 1st, 2017

• Increased from 3 breastfeeding options to 5 options.

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Old Infant DS New Infant DS

Why change?

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What does exclusive breastfeeding mean?

• Only breastmilk from the mother, or expressed breast milk given in a bottle.

• No formula, water, juice or other foods.

• Could receive vitamins, mineral supplements or medicine.

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Mothers should exclusively breastfeed for 6 months.

• In 2000, the DHHS Office on Women’s Health published the first departmental policy on breastfeeding, the HHS Blueprint for Action on Breastfeeding.

• Recommended by the• American Academy of Pediatrics (AAP)

• American Academy of Family Physicians (AAFP)

• American College of Obstetricians and Gynecologists (ACOG)

• Association of Women’s Health, Obstetrical, and Neonatal Nurses (AWHONN)

• Le Leche League International

• National Medical Association (NMA)

• Centers for Disease Control (CDC)

• World Health Organization (WHO)

• UNICEF

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Exclusive breastfeeding is healthier for infants.

Benefits of breastfeeding seen in a dose-response relationship. More and longer is better.

• Comparing ever BF’ing with exclusive formula feeding, the risk reduction of acute otitis media was 23%. When comparing exclusive BF’ing with exclusive formula feeding, the reduction was 50%.

• Exclusive BF’ing greater than 3 months reduced risk of atopic dermatitis by 38%.

• Infants exclusively BF for at least 4 months had a 72% reduction in risk of hospitalization due to lower respiratory tract disease.

• Development of gastrointestinal infection reduced by 64% in infants exclusively breastfed.

Ip S, Chung M, Raman G, Chew P, Magula N, DeVine D, Trikalinos T, Lau J. Breastfeeding and maternal and Infant Health Outcomes in Developed Countries. Evidence Report/Technology Assessment No 153. AHRQ Publication No. 07-E007. Rockville, MD: Agency for Healthcare Research and Quality, April 2007.

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Practicalities of completing the discharge summary

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If you have any other breastfeeding questions, contact Marji at CyrulM@Michigan.gov

Join us Tuesday, December 19th 1:00-2:00 for our next breastfeeding webinar.Breastfeeding when there is Lead in our Water Supply with Dr. Eden Wells, MDHHS state Chief Medical Executive. Many communities across the United States struggle with lead levels in their water systems. Exposure to lead has raised questions regarding the safety of initiating and continuing to breastfeed. Parents and care providers will learn the effects of lead exposure and how to reduce risk while continuing to breastfeed.Register here: http://mibreastfeeding.org/network-series

MIHP Coordinator MeetingsQuestions and Answers-Part 1

Can we get confirmation that the Personnel Roster was

received when sent via email?When emailing the Personnel Roster, please

send the email with “email receipt” required.

Please explain the rationale for submitting the Personnel Roster

more than every quarter.Personnel Rosters must also be submitted when

staffing changes occur. Mark the appropriate check box when submitting to indicate

submission of quarterly roster and/or staffing changes.

When we reach out to the Health Plans for services, do we contact/reach out to our MIHP representatives or go through

customer services?

Please contact the MIHP representative.

When the Michigan Dental Registry go into effect?

November 1, 2017

Will we need a MDHHS consent release signed for a sibling to send a

referral for that sibling to MiDR?The signed consent covers all children of the

beneficiary.

Where can Coffectivematerials be found?

Please visit the web link below for materials that are free-of-charge:

http://coffective.com/store/

**Free materials are also available on the MIHP website

Is the certification/accreditation process continuing on schedule

at this time?Yes, it is on schedule. Please contact a MIHP

Consultant, if you have specific concerns.

We need updated Medicaid Health contact information,

including fax numbers.Please contact the Medicaid Health Plan(s) your agency is under contract with for the most up-

to-date contact information.

How will the new Professional Visit Progress Notes and Maternal Plans of Care-Part 2 effect older charts?

The new PVPN, POC1 and POC2 will not impact open charts. Beneficiaries enrolled after

February 1, 2018 will utilize the new documents (i.e., PVPN, POC2-tobacco, alcohol, and

substance misuse).

If you have a mom that has scored moderate risk in abuse/violence and you also implement high

risk interventions, will this count against you during certification for discharge indicators?

Yes, you are only allowed to document interventions at or below the assessed risk level. If your professional

judgement dictates the need to change the risk level and utilize high level interventions, follow the proper procedure

to communicate the risk level change. The interventions are not to be documented on the Discharge Summary, if

they are higher than the risk level determined at assessment.

How many visits are allowed for an infant over 18 months of age, if

approved by a MIHP Consultant?The maximum number of visits for a Substance-

Exposed Infant is 36. The number if approved visits after the age of 18 months should be the minimum number of visits needed to transition the toddler to

the appropriate agency for continued services.

Are copies of the MCIR record required in the chart?The MCIR record, or screenshot of an attempt to locate the

MCIR record, should be printed and reviewed with the beneficiary and documented in either the contact log or

professional visit progress note., effective February 1, 2018. Immunizations must be discussed with maternal beneficiaries at least once during enrollment and at each professional visit

for infant beneficiaries.

What if the mother and/or infant do not get vaccinations?

This should be documented in the beneficiaries chart/record.

Can lines be added to the Action Plan section under “some things that could

get in the way of my goals”?

The Action Plan document posted on the MIHP website is a Word fillable document that allows ample space for documenting in “some things that could get in the way of my goals” section.

What is the timeframe that the Action Plan must be completed?There is not a designated time frame, however,

as soon as possible would be the best case scenario and is required prior to discharge.

Is the Safety Plan we used today the required Safety Plan to be

used for domains, which require a Safety Plan?

The MIHP Safety Plan found on the MIHP website is the required Safety Plan.

How do we enroll moms in any special motherhood programs, such as THC-

Destination Motherhood or UHC-Baby Block?

Provide a referral to moms for the programs listed.

Do all interventions have to be addressed in a domain for a

beneficiary?No, it is not required to address all of the

interventions.

Are anymore quarterly meetings with the Medicaid Health Plans

scheduled?Not at this time.

Is inactivity considered no home visits for four months? Do attempted contacts count?

No face-to-face contact with a beneficiary is considered inactivity. Attempted contacts are

not activity.

Is the discrimination scale for MIHP only targeted toward racism and health equity?

The discrimination scale addresses many forms of discrimination.

What is considered timely entry of a beneficiary discharge

summary?A discharge summary should be entered within

thirty days of discharge. For specific criteria, please refer to the MIHP Operations Guide.

In Cycle 6, the charts reviewed were from a satellite office, if the agency had more than one office. What is the plan

for Cycle 7?

The charts reviewed are determined by the certification team and may be chosen from a

satellite or a non-satellite office/location.

Can we do away with the care coordination agreement, if we

have a contract?Per the MIHP Operations Guide: Care Coordination Agreements (CCAs) are

separate from contractual agreements. MIHP providers and Medicaid Health Plans (MHPs) must establish and maintain a Care Coordination Agreement

(CCA) for both in-network and out-of-network services. The intent of the CCA is to explicitly describe the services to be coordinated and the essential aspects of

collaboration between the MHP and the MIHP provider. MIHP providers are encouraged to establish Care Coordination Agreements (CCAs) with all MHPs in

their service area, although a MHP is not required to establish a CCA with all MIHP providers. Contact your MHP contract/provider services liaison, if you

have questions about or need assistance in obtaining or updating a CCA.

Should marijuana be on the Tobacco Plan of Care-Part 2?Marijuana use is assessed on the Maternal Risk

Identifier and is to be documented on the Substance Misuse Plan of Care-Part 2.

Will all of the Maternal Plans of Care-Part 2 have the same

format?Yes, they will after all are revised and updated.

Does the Maternal Substance Misuse Plan of Care-Part 2 replace the Drugs or

Substance Exposed Infant Plans of Care?

The Substance Misuse Plan of Care-Part 2 replaces the Drugs POC2. The Substance Misuse is a risk domain that will score out on the Maternal Risk Identifier and is required to be used prenatally. It is an optional POC2 postnatally and may be used throughout the perinatal period

based on professional judgement. The Substance Exposed Infant Plans of Care-Part 2 are required to be utilized based on the results of the

Infant Risk Identifier.

Substance Misuse POC2=adult

SEI Plans of Care 2=infant

If documenting under the ‘plan for next visit’ progress note that an infant will have a weight

check or help with breastfeeding in one week, is that sufficient documentation for seeing a beneficiary more than once in a month?

Yes, both are sufficient rationales.

Announcements

• Both Dr. Ondersma and Dr. Estes videotaped presentations are posted on the MPHI website

• The recorded Case Management presentation is posted on the MPHI website

• New MIHP fax number: 517-763-0366

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Please contact assigned MIHP Consultant

Questions?