Title page

Contents

Highlights 2

Letter 7

Background 11

EHDI Program Role in the Screening, Diagnosis, and Referral Process for Hearing Loss 11

HHS Agency Roles in the EHDI Program 14

Disparities i.n Access to EHDI Services 16

HRSA Measures EHDI Program Performance Primarily through Benchmark Data 17

HRSA Assesses State EHDI Programs Based on the Percentage of Infants Meeting Benchmark Targets for Hearing Screening, Diagnoses, and Enrollment in Early Intervention Services 17

Performance Measure Change for EHDI Benchmarks Should Allow HRSA to More Accurately Track State Progress 20

HRSA and CDC Provide Technical Assistance and Take Other Steps to Address States' Challenges Meeting EHDI Benchmarks 25

HHS Efforts to Promote Language Acquisition Include Seeking State Input, and Efforts Are Underway to Address States' Challenges 28

HHS Actions Include Requiring Plans for Reaching Underserved Populations, but States Are Not Required to Report Progress 32

HRSA Sets Requirements for States to Support Families; Selected States Used Various Strategies to Provide Support 39

Conclusions 42

Recommendations for Executive Action 42

Agency Comments 42

Appendix I: Objectives, Scope, and Methodology 44

Appendix II: Early Hearing Detection and Intervention (EHDI) Grant and Cooperative Agreement Programs 48

Appendix III: Promising Practices to Address Disparities in Access to Early Hearing Detection and Intervention (EHDI) Services 49

Appendix IV: Comments from the Department of Health and Human Services 52

Appendix V: GAO Contact and Staff Acknowledgments 54

Table 1. Comparison of Two Early Hearing Detection and Intervention (EHDI) Program Performance Measures for the 1-3-6 Month Benchmarks 21

Table 2. Underserved Populations Targeted by State Early Hearing Detection and Intervention Program (EHDI) Diversity and Inclusion Plans 36

Table 3. Early Hearing Detection and Intervention (EHDI) Grant and Cooperative Agreement Programs, 2020-2029, by Awarding Agency and Period of Performance 48

Table 4. Examples of Promising Practices to Increase Access to Early Hearing Detection and Intervention Services for Underserved Populations 50

Figure 1. Sources of Data for State Early Hearing Detection and Intervention Programs 12

Figure 2. Hearing Screening of a Newborn Infant 13

Figure 3. Early Hearing Detection and Intervention (EHDI) Program Benchmarks 18

Figure 4. Number and Percentage of States Meeting Early Hearing Detection and Intervention 2020-2024 Grant Period Performance Targets, 2020 Birth Year Data 19

Figure 5. Comparison of Two Measures for the Percentage of Infants Screened for Hearing Loss before 1 Month of Age, 2008-2020 22

Figure 6. Comparison of Two Measures for the Percentage of Infants Diagnosed with Hearing Loss before 3 Months of Age, 2008-2020 23

Figure 7. Comparison of Two Measures for the Percentage of Infants with Hearing Loss Enrolled in Early Intervention by 6 Months of Age, 2008-2020 24