The Newborn Hearing Screening Toolkit

The HRSA-MCHB-funded National Initiative for Children’s Healthcare Quality Learning Collaborative “Improving Follow-Up to Newborn Hearing Screening by Working Through the Medical Home," conducted in collaboration with the National Center for Hearing Assessment and Management (NCHAM), led to the creation of a series of tools and materials designed to improve the system of care for all newborns with possible hearing loss. 

In response to numerous requests from states that wish to take advantage of materials that have proven useful, we are posting a number of tools that can be downloaded for use in your program. Just click on the name of the tool below, and you will be linked to a Word or Publisher file that you can download and customize. If you have any questions or comments, or would like more information about any of these tools, please contact Emma Smizik at


Improving Follow-Up to Newborn Hearing Screening by Working Through the Medical Home project was conducted by the National Initiative for Children’s Healthcare Quality (NICHQ) in collaboration with Maternal Child Health Bureau (MCHB) and National Center for Hearing Assessment and Management (NCHAM). The project focused on strengthening relationships between all stakeholders in the continuum of care for infants who did not pass the newborn hearing screening and their families. 

NICHQ facilitated a Learning Collaborative for eight state teams (Arizona, California, Florida, Kansas, Michigan, Nebraska, Pennsylvania and Wisconsin) who tested and later implemented a set of changes designed to reduce and/or eliminate delays or loss to follow up for infants with hearing loss. The Newborn Hearing Screening Learning Collaborative took place from October 1, 2005 through October 31, 2007, a 25 month period and included a special training component for participating Title V members.  

Team participants represented each phase of the process and typically included, nurses from the hospital screening program, audiologists, early intervention providers, primary care providers, state Chapter Champions from the American Academy of Pediatrics (AAP) and Early Hearing Detection and Intervention programs (EHDI), and parent partners. Participating teams used the Model for Improvement to make changes in six different domains, each focusing on one phase of the newborn hearing screening program during the first year of life: preparation and planning, screening, referral to audiology, diagnosis of hearing loss, identifying the etiology, and intervention with enrollment in early intervention.

Participating teams developed numerous tools and materials to assist the care providers to enhance communication between providers and build reliability into the care processes.  Other particularly valuable change concepts were standardizing tools, developing scripts for communicating with parents, and removing inefficiency in system processes.

Toolkit (*All tools below are in Microsoft Word format unless otherwise noted)


Screening Communication and Forms

Screening brochure in Spanish: NE-EHDI Initial Screen inside Spanish 06 & NE-EHDI Initial Screen outside Spanish 06
Screen Parent Education (NE)
Screening Birth Center Data Collection Tool (FL) (Microsoft Excel file)
Screening Fax Back Alert to PCP from State (MI)
Screening PCP Notification Letter (PA)
Screening Script No Show Phone Call (CA)

Parent Notification of Hearing Screen Results

Screening Parent Notification Form (FL)
Screening Parent Notification Letter (PA)

Parent Roadmap: The Path through Screening, Diagnosis and Intervention

All Parent Checklist (CA)
All Parent Roadmap (CA)

Audiologic Diagnostic Forms

Audiologic Screening and Diagnostic Report Form (NE)
Diagnosis Referral and Tracking Form Audiology EI (AZ)
Referral Fax Back PCP to Audiologist

Early Intervention (EI) Forms

Early Intervention Communication Plan Example
Early Intervention Fax Back Form Verify Enrollment (MI)

Parent Survey

All Parent Survey English (CA)
All Parent Survey Letter (CA)

CAN DO Playbook - Click to get started

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