Karl White:
Good morning. My name is Karl White. I'm the director of the National Center for Hearing Assessment and Management at Utah State University, and we are delighted to welcome you all here to the 2025 National EHDI Conference. We're looking forward to a great plenary session. Many of you attended instructional sessions yesterday, we hope it gave you an opportunity to learn some new things and meet some new people. Probably one of the most important things about the EHDI conference, at least in my opinion, is the opportunity it gives us to get to know new people, learn about new ideas, critique what we're doing, and go home re-energized and ready to go about our work and improving EHDI programs.
In the next two days, there'll be almost 900 of us who have that opportunity. And one of the things that is so great about the EHDI Conference is that it gives us an opportunity for people who have different ideas, different perspectives, different experiences, to come together, talk to each other, share what they know. We want to do everything we can to make sure that that happens in a respectful atmosphere so people feel comfortable talking with each other, we would never want anyone to feel unsafe here. So in spite of the great enthusiasm we have for the way we're used to doing things, we encourage all of you to keep an open mind, go to a session that you know nothing about so that you have an opportunity to learn what other people are doing, and then watch those opportunities to work with and build each other.
Later in the conference we will recognize the planning committee whose time and dedication, [inaudible 00:01:52] and what we believe will be the best EHDI conference yet, we'll recognize all of those members of the committee later at the next plenary session. But at this time, we'd like to especially recognize the people from Pennsylvania who participated on the final committee. Martha Beal... If you're here, please stand up and we'll give you a round of applause in a moment. Martha Beal, Nicole Corbin, David Davis, Anne Gaskich, Michelle Arfit, and Marianne Stefko. So please join me in giving them a round of applause. There is one member of the planning committee I'd like to personally extend a really heartfelt appreciation for all she's done over the years. Mandy McClelland, who is on our staff at NCHAM. Mandy does so much behind the scenes in organizing those planning committee meetings and getting ready for the conference, and you don't see much of her because she's busy making things run smoothly. But without Mandy this conference would not happen in nearly this same way. So Mandy, why don't you to just stand up.
We also want to extend the special thanks to the nine organizations that have contributed as sponsors to the 2025 EHDI Conference. This year we have two gold sponsors, Cochlear and Regeneron. We have two silver sponsors, Akouos and Medel. And we have five bronze-level sponsors, the American Society for Deaf Children, Gallaudet University, HearX, Phonak, and Revvity. These people provide financial support but also a lot of emotional support to make this conference successful. And so I want you to recognize them and to spend time in the exhibit hall, there are about 35 other exhibitors in the exhibit hall. And that's an important part of this conference, it gives you new materials, new ideas, and these are people who are every bit is committed to the goals of EHDI as all of us are committed to it. So please reach out to them and make sure they know about how much we appreciate what they do.
We would like to encourage you to wear your name badge so that people will know who you are. If people have to squint at the name badge just a little bit, that's okay, be patient with it. But please take this advantage to get to know new people, this is what makes EHDI the success that it is, is having so many different people involved. We also encourage you to sign on to the app, and if you have any trouble signing on to it, please just talk to the people at the registration desk. The paper program book was up-to-date as of a week ago, but we had a number of people because of travel restrictions and other issues that were unable to come at the last moment. So the app will be the source of the most current information, and it's also the place where you'll go to do conference evaluations for each of the individual sessions as well as for the general sessions.
We also encourage you to visit the posters that are set up outside both the exhibit hall and this general session hall. We've added a new feature this year for the People's Choice Award, so we have a subset of the planning committee who is the poster award committee that has already judged and selected the people who will be winners as opposed to the poster awards, but the People's Choice Award is up to you. So we encourage you to go visit those posters, there's a QR code that you click on it and then you tell us what think is the best poster out there.
A few notes about food, the morning beverage break and the afternoon snacks will be served in the exhibit hall, it gives you another opportunity to visit those exhibits and talk to the exhibitors. There are water stations set up in the convention center, there are no water stations in the individual rooms, just the way this facility handles it. So if you brought a water bottle, you can fill them in those other stations or you can go in between sessions to where those water stations are. There are also a drinking fountains located near each of the restaurants. For lunch today and tomorrow, there are literally hundreds of restaurants within a 10-minute block from this convention center, but the hotel will also be setting up some grab-and-go food options. You can't pay with cash, you have to have either Apple Pay or a credit card, for those grab-and-go options. So during lunch today, we encourage you to visit... That's when the poster presenters will be at their posters that they can talk with you about what they did or answer questions. So between 12:00 and 1:45, today is the best time to visit the posters.
Okay, I'd like to take just a moment on a personal note and share with you some of my feelings about this year's EDHI meeting, for just a moment. So this is a real cowboy, it happens to also be my father. He was a veterinarian, a large animal veterinarian, mostly, and he was the original horse whisperer long before even people knew that that was a term. And I grew up, because of him, on horses, from the time I was a little boy, I was riding a horse. When I was about eight years old, my father took me out to the ranch and said, "We've got 50 or 60 horses here who aren't broke, who aren't trained." He always used the word train instead of brake, but he said, "Every horse on the place except for these five are for sale. You train them, sell them. You can put the money in your college fund." And so I grew up training horses from the time I was about eight years old.
As I got older, me and my brothers and my dad went on pack trips and as I started thinking about a family, I was lucky enough to meet someone who was as committed, or probably more committed to riding horses than I was. And so we fell in love and started the family and the kids came along and they spent their time on horses as well. And then grandkids came along and they spent their time on horses.
I want to tell you just a short story about this horse and me. So this horse was named Spindles and I was training Spindles. Sometimes I had a saddle that fit, in this particular picture, it didn't quite fit, but that was okay. And it was winter time in Northern California where we lived and there was an unusual amount of rain that year, and we kept our horses about 15 miles from town, on what we called the ranch. And my dad said one day we need to go check on the horses that are in the back pasture, the back [inaudible 00:09:47], and to get there you have to cross the creek. So we went out there and saddled our horses, just the two of us, and we rode out to the back. And when we came to the creek, I'd never seen it, usually it was four feet wide and four inches deep, but there was a lot of water there. And I said, "How are we going to get across that raging river?" He said, "You'll be fine. Just ride down in good, Spindles knows what she's doing." He said, "So you don't get too wet, pull your feet up out of the stirrups and perch on top of the saddle, then you'll be okay." And he was right, we rode across that creek or river, and went out and checked horses, they were doing fine.
And so on the way back we came in, and Spindles was a pretty smart horse, she had figured this out. And so my dad rode down into the creek on this big black horse and I followed on Spindles, and spindles waited until I got my feet up out of the stirrups, and then she shook a little and bucked a little bit, and I went off into the creek. And I had a big winter heavy coat on with my chaps and my boots, and I was sure that this was the end. I was a wrap, right there in that river. And I [inaudible 00:11:02] around for a few minutes and was fortunate enough to reach the shore, and I looked up and there was my dad on that big black horse, just laughing, he was about to fall off of the saddle. And I said, what are you laughing for? I could have drowned." And he said, "I wasn't too worried," He said, "The creek's only three and a half feet deep, you just had to stand up."
So I tell that story because I think this is a somewhat fraught time in the EHDI world, and much of the other world, there are colleagues who would've been here this morning who couldn't travel, there are colleagues who have had their Department of Education grants canceled. And I think through all of this, it's important for us to think about and remember what EDHI is and what it's accomplished. That we not lose our perspective, that we know that what we're doing is the right thing, and in my opinion, it's going to you endure just fine. We'll be here next year, and the year after, and the year after that. And EDHI Programs will continue to improve and will continue to bless the lives of children and families, and we shouldn't lose our perspective. If we keep the perspective that what we're doing is the right thing and we're serving people and we're all in this together, then wonderful things will continue to happen. Certainly in my life, being involved in EDHI programs is one of the things that I'm most grateful for, because I've seen how it changes people's lives and that's why we're here all together.
And... Thank you. And I can't think of two people to kick this off. Who more exemplify that attitude towards life and towards certain families than Teresa Caraway and Jace Wolfe, I've known them for many years. Teresa is the chief executive officer of the Oberkotter Foundation and at Hearing first, she has a spectacular career in serving families of deaf and hard of hearing children. Jace Wolfe is the senior vice president for innovation at the Oberkotter Foundation. Together, they very involved in the Hearts for Hearing program, in Oklahoma City. I'm not going to read you their bios because you can read them in the program book, but I often say that one of the greatest blessings of being involved in EDHI programs is that you get to know people who are nice, competent and hard-working, and that describes Teresa and Jace to a key. They have some very exciting information to share with us, I think you're going to love their session. I haven't seen it yet, but I know the kind of work they've done and I'm really looking forward to it. So with that, I'm hand over to Teresa and Jace.

Teresa Caraway:
Well welcome and may the EHDI force be with us. This is wonderful to be in a group of people and I want to say a special thank you, Karl. Thank you for that wonderful nice introduction, and for your leadership throughout the years and as we continue to come together. Thank you to the NCHEM team for organizing this opportunity for us to connect, and to learn, and to grow and exchange ideas. So Jace and I are excited to be here. And it takes the efforts of many to pull this conference off and we don't have time to say thank you to all the many efforts, but there's two people and probably individuals that don't get recognized enough, and that is our interpreters that provide us the opportunity to have access and communicate with one another, and this amazing tech team who makes it all possible. They're the unsung heroes within our convention. So without... So we're excited to be here. And I'm Teresa, and these are my disclosures that I owe the CEO of the Oberkotter Foundation and Hearing First.

Jace Wolfe:
Hello, EHDI troopers. My name is Jace Wolfe. I'm an audiologist by training and also the senior vice president of innovation at the Oberkotter Foundation. And together we have put together what we hope is a very fun, informative, and positive session, today. We have some themes or goals that we want to try to achieve today. We want this opening session to be a celebration, a celebration of what we've accomplished over the last 25 plus years together, we should all throw our shoulders out of socket, patting ourselves on the back for the accomplishments that we've achieved over the last two decades, plus. We want to celebrate what's possible for children with hearing loss today, because of your hard work. We want to convey, especially to young professionals, but most especially to families of children with hearing loss who might be in the audience today, we want to convey a message of hope, that when we come together, EHDI professionals and families, we can help you reach your goals and dreams for your children. We can help your children reach their full potential together. We also want to emphasize just how important the 1-3-6 initiatives still are today, that sets the foundation for everything. If we can get it right in that 1-3-6 period, then the outcomes of children with hearing differences are going to be exponentially better, across time.

Teresa Caraway:
And we also want to keep our eye that there are 3,600,000 babies born across the United States every year. And our role, we have a huge opportunity, that we screen every baby before they leave the birthing center or their hospital, so that every baby can receive the full benefit of new born hearing screening and reach their full potential. So we're going to share a little bit about the Starts Hear Campaign, and what we're doing to make our jobs easier and to support the work of the EHDI force.

Jace Wolfe:
We're going to share with you some of the outcomes that have been achieved with EHDI since 2000. We're going to stress the importance of early identification. We're going to talk about what's not possible, but what's probable for children with hearing differences if we do what it takes, when we identify those hearing differences at birth.

Teresa Caraway:
And then we're going to wrap it up with what are our opportunities to come together to work together, so that all children reach their full potential. So let's get started.

Jace Wolfe:
All right, so let's stick with the space theme. And I want to start out with what is one of my favorite quotes, it comes from a gentleman, Norman Vincent Peale. He wrote a book in 1952 and it is still relevant today, that book is called The Power of Positive Thinking. It's a self-help book, it's a motivational book. He was probably the first self-help guru before there was a self-help guru on every corner of the internet, and the books full of great information. One of the quotes that really resonated with me in that book, Mr. Peale said, "Shoot for the moon, even if we miss, we'll land amongst the stars." From a standpoint of starting, that's nowhere close to true, I looked it up, I googled it, the moon is a couple hundred thousand miles from the earth, and the closest star is about 90,000,000 miles. So even if we hit the moon, we're still going to be a long ways away from the stars. But I think you get the point, that if we set our goals high and we do everything we can to achieve those goals, we're probably going to be happy with the outcome.
And why I love that quote and why we decided to start with that quote today, is that we truly believe that with modern pediatric hearing healthcare services, what we can do together as EHDI professionals and families of children with hearing loss, that age-appropriate listening and spoken language outcomes, they're not just possible for children with hearing loss, they're probable. And if we come together to do what it takes, we truly can shoot for the moon. How do we do that? Well, we rely on EHDI and we don't rely on Obi-Wan, we don't rely on Skywalker, we rely on the EHDI force.
And if you can see here, hard tech just right off the surface, ut that's Obi-Wan White there, Karl White, AI interior. Obi-Wan could be the AI and then Karl White. And what you can see on the bottom right corner of the screen is not Luke Skywalker, it's Jacob Skywalker. Jacob Skywalker was born in Oklahoma, in 2005, with severe to profound hearing loss. And as we progress through this session today, we're going weave Jacob's story throughout our message, to show what is possible when we come together as EHDI providers with colleagues, to help families reach their goals and dreams for their children.
So let's start with a celebration, and we really should be proud of this. If we look at what has happened in just a relatively short amount of time with the implementation of the first EHDI programs, in the late '90s and early 2000s, today, we are screening almost 98% of children who are born in hospital settings today. That is so remarkable, when you think of the extraordinary efforts logistically, the systems that have to be put in place. Screening babies is not the easiest thing to do in the world if you've done that, and the fact that we're able to achieve that in 98% of babies is just remarkable. When we do that you can see on this figure on the right, that prior to the implementation of newborn hearing screen, we identified children with hearing differences, typically somewhere between about two to three years of age. When we execute EHDI appropriately, we can now identify children in the first few months of their life, and that makes all the difference in the world. And again, we're doing that with a great level of success. If we look at the most statistics that are posted on the CDC website, and from year to year, over the last several years, we're screening about 98% of babies that are born with hearing loss.
And that has led to identification of hearing differences at a much earlier age. And for many, many more babies, we're identifying almost three times more babies, in 2022, the most recently available statistics, than we were in the early two-thousands. And so once we know about those babies hearing status, we're in a position early on to get them the services that they need, to make it more likely to reach their full potential. Why does this matter? It matters because time matters. Time is so essential if you're born with hearing differences, and this is true for all children, regardless of what the goals and dreams are of the family, regardless of what their choices are and how they're going to communicate with their baby, we have to be able to provide babies with the supports and the services that they need from day one.
And we know this is true from neuroimaging studies, this comes from Karen Emory's lab, she's a neuroimaging researcher out in California, and she has shown, as you can see in this figure, the child on the left who was born with hearing differences and didn't have access to auditory stimulation during the first few months in years of life, you can see a reduction in the white matter tracts in the auditory areas of their brain, what's called Heschl's Gyrus, which is the primary auditory cortex. And that's really critical, white matter tracts are the fiber tracts that share auditory information with the rest of the brain, so we can code that auditory information into a meaningful signal that the frequency, the intensity or the loudness, the duration cues that are in sound, we can convert those into phonemes, which are the fundamental elements of the spoken and written word. We can convert those into words, we can make sense of the sounds that we hear because those white fiber tracts share that information from the auditory area of the brain with the rest of the brain, where it can be comprehended.
We know that's true from other studies. [inaudible 00:26:07] Yuan and Nancy Young, colleagues at the University of Chicago have used neurodegenerative measures to look at gray matter development in the brain, as a function of auditory stimulation. And we know if a child is born with hearing differences and deprived their sound during the first few months of life, we see a reduction in gray matter as well, because of the pruning of the synapses, and the neurons, in the auditory areas of the brain. And this is all really important because it affects outcomes, it affects the behavioral performance of children with hearing loss. And if we look at language outcomes, these come from the Longitudinal Outcomes in Children With Hearing Impairment Study, a study that was conducted in Australia with hundreds of children who were born with hearing differences. And we can see that language outcomes are typically... They'll fall on the typical range if we can identify a child early and we can provide a cochlear implant by six months of age.
But from that point forward, every six month delay in the provision of a cochlear implant for a child results in a six-month delay, or excuse me, a one half standard deviation delay in their language outcomes. So what does that mean? The mean score on a standardized test of language is 100, and so if a child is born with the potential to score 100 on a standardized measure of language assessment, and we delay from six months to 12 months, the provision of a cochlear implant, then that means, based on these data, that their standardized score would be around 92, instead of 100. If we delay from 12 months to 18 months, their standardized score will be 85. So time matters, time is of the essence. We know that if we look at the Lockheed Study, later, when children are prepared to enter in the school at kindergarten age, the age of which they received their cochlear implant was the most important factor that predicted their language aptitude at kindergarten entry. So I'll hand it over to Therese here, she's going to summarize.

Teresa Caraway:
Yeah. So time matters is what you're saying. And one of the things that we know is that one of the benefits when you have been in the profession for a while, several years, if you've been in the profession before newborn hearing screening, how many of you remember that if you met a child who was three, three and a half and you were excited to find them because they were identified before four years of age? Anyone remember the good old days? Yeah. And now we expect to have babies that we identify hearing loss within days and weeks of birth. And today, if we meet a baby that's nine months old, 12 months old, and we're just being identified, what do we say? Where have you been? And we now know, and that we have the science that tells us what we've been seeing in our practice, that time matters, and that we have to really think about this whole business of early identification that we're in, and this opportunity for the 3,600,000 babies born across the United States. Why? Because it's about their brain development and about their language development.
So one of the things we know is that expectant parents really need to be fully aware of the importance of hearing to child development, the importance of knowing their status of their baby's hearing, that they really anticipate that their baby will have their hearing screen, that they know to pay attention to the outcomes and they know to act urgently, should their baby fail screening. And yet we have a BKS problem, a best kept secret. In other words, parents, families, go to have their baby, and at the time of birth, it never occurred to them that their baby would have their hearing screened. It still is not on the radar, and yet we know how critically important it is for that child and their child's future to know the status of their baby's hearing. So one of the things that we want to change is we have to change that best kept secret. We have to make sure that expectant parents know the importance of newborn hearing screening, know that their baby will have their hearing screened. And so I'd like to introduce you to the Skywalker family, and the story of a family, and as they tell their story and their experience of having their baby, their second child and what that experience was like. And I think you'll hear some very common themes that we run into.

Speaker 4:
On March 28th, 2005, almost 20 years ago, our second child was born. And that day the nurse came in the hospital room and she said, "Your baby failed his hearing test." And I really didn't even know what that meant. I was not alarmed, I was like, "Okay." I didn't really think it meant anything bad. The nurse was actually telling me things as to maybe why he failed the test, she was saying, "We don't have the greatest equipment here in the hospital." And she would say, "He might have fluid behind his ears, so that's probably why he failed the test." I wasn't worried.
Well, like I said, at the first two tests in the hospital, I wasn't worried, I didn't believe it. But when he failed the third test, just pure sadness, fear, I was just completely distraught. We were scared. I mean it's like we were just blindsided with... We were not expecting that at all. And things go through your mind when you're expecting baby, like, "What if this is wrong or this is wrong?" There's a thousand things that can be wrong. But never once did we say, "What if he's born deaf?" That thought never occurred to us, whatsoever. I mean, it just came out of the left field. We were lost, we didn't have what in the world was going on. We didn't know what to do.

Teresa Caraway:
Very familiar things, isn't it, of what you hear, in terms of what parents can encounter and what their experiences are when they're having a baby? So most babies are born to two hearing parents and typically it comes to them out of the blue. And when you're caught off guard with something out of the blue, you suddenly become almost paralyzed to believe it, don't you? And don't know what to do. And if you don't know what you don't know, it's hard to figure out where to begin and what to do. And I think you can hear that in this family as they tell their story.
So one of the things that we look at is we think about the family journey and there's many steps along the family journey that we have identified. And we have been in the business of, "We're on this journey and we meet families at the time of newborn hearing screening at the time when that baby's hearing is screened." But as we think about it and as we look at, what all happens prior to that newborn hearing screening. And so we know that right now when parents are not aware of the screening, when they're caught off guard, when they don't know what they don't know, they don't even know their baby's going to have their hearing screened, we know that what leads to... And then what happens is that 34% of babies who fail to do newborn hearing screening do not receive the follow-up care that they need. And that's what we want to change as well, isn't it? To improve that.
So one of the journeys that the Oberkotter Foundation went on, is we began to ask ourselves, how can all babies benefit a newborn hearing screen? And we began to think about it and we began to look and think about all the barriers on a family journey. And we thought, "Maybe the best thing we need to do is we need to go to the source. We need to go directly to parents, we need to find and learn from them. We need to..." Because if we're trying to solve this problem and support them, in terms of knowing about hearing and knowing about the status of their baby's hearing, we need to talk to them. And rather than a group of experts sitting around a table... So we went with a human-centered design and created a research study. And what that meant is we conducted surveys, virtual interviews, and even home interviews, with parents, so that we could learn from them about what their experiences were, what would make a difference for them, and what they needed and what they wanted.
So we worked with EHDI coordinators from three states, Idaho, Texas, and New York, we, through that process, identified 300 families that were surveyed. We then followed up with 20 in-home visits across those same states and then also included Alabama in that. I never thought in a million years that a family who had a baby that failed screening, that never followed up, would allow us to come into their home to interview them about that process, and about why they never followed up on the newborn hearing screening, but they did. And we learned a lot from the 300 families and from these 20 families that we interviewed. We also then conducted provider interviews, virtual interviews from those same states, and then through then also Kentucky, California and Louisiana. And that consisted of pediatricians, it consisted of audiologists and birthing center hospital personnel. So we began to get a pretty good picture through this ethnographic research, of what parents needed, what parents wanted and what parents... So that we can best support them.
And here's what we found, we found some key themes that started emerging. And one of the things that stands out, is that families have a bunch of hurdles. I don't know if you've noticed that too, but they are navigating a very broken system, and that system can differ depending upon what state they live in, what part of the state they live in, what city they live in, urban versus city, wherever they live, it's very different, isn't it? And that's what makes our jobs a little bit difficult because we're covering the entire country, and plus the territories. And we know that that can be highly variable, we also know that run-in providers with variable information about the importance of newborn hearing screening, about what the opportunities are today for children who are born deaf or hard of hearing. And through all of that, and through the uninformed and the misinformation, this lack of awareness leads to lack of action.
And many parents, as I said before, they don't even know their baby's going to have a hearing screening before they leave the hospital. So the screening even comes as surprise, let alone if their baby fails that screening. And so they're often very unprepared for what to do or where to turn, and they fail to even notice those screening results because they underestimate what the importance of it is. If they've never heard about it, if they've never known about it, then it must not be that important, right? I have to admit, my degree is in speech language pathology, I've been doing this now for many years, but when I was having my babies, it never occurred to me that my baby could have hearing loss. They were born the typical hearing, but it wasn't on my radar, and here I am in this business. So it catches parents out of the blue. And that's that importance of raising awareness because it creates the urgency and knowing to follow up.
We also found that when you're aware there's people... That parents follow up, there's higher follow up rates. That we also learned that families didn't even know that their baby would have a screening, and they also didn't know what to do if their baby failed. But one of the things that we did find out, is if parents were more aware, they were more apt to follow up. And so the research showed that when parents were aware of the newborn hearing screening, prior to the birth of their baby, there was a 25% more likeliness that they would follow up urgently on that failed screening. So essentially awareness leads to active parents and it all starts with awareness. And because parents, and most probably the general population, don't realize how important that knowing the status of a child's hearing really is to their overall development. And when you don't know, you don't pay attention to what those results should be.
So what happens is that then the parents are hit... All this new stuff with babies... How many of you have brought a baby into this world, have been new parents and realize they don't come with manuals, do they? There's a lot to learn, there's a lot to adjust to. And so what happens is that newborn hearing screening results just fade into the background because there's all kinds of other things going on. But one of the things that we found is that no matter... That once parents were aware of the importance of hearing for brain development, for language and literacy, once they got that, they got it. And parents will battle through anything to make sure their baby has the services that they need, and all of the necessary follow up. And one of the key findings that we found, this was true no matter the socioeconomic status and no matter the maternal education level, and that's important.
So the messages that we provide in the awareness messages about, "It's about your child's brain development. And because your child's brain development is so important, what we need to do is we need to follow up." So we can focus on newborn hearing screening, and as a result of the studies, and the research and what parents told us, we realized that we needed to rethink where our messaging was happening. We could not wait until the hospital setting to suddenly now educate families about newborn hearing screening, that their baby was going to have their hearing screen and what it meant. That was too late in the family journey. So we began to look at what point could we intervene that we could, if we could tip a domino, we had a more likely chance of impacting that entire family journey? And answer was pretty evident, and that is that we need to begin our messaging about newborn hearing screening at pregnancy, when the parents are expecting their baby, about the importance of that their baby is going to have their hearing screen and to know the results of that, and to follow up urgently. And that's how Starts Hear, a National Public Awareness Health campaign began, to message to expectant moms and to expect parents about the importance of hearing screening and knowing the status.
So what is it? What is Starts Hear? It's essentially a very comprehensive, multimedia, a public awareness campaign, and we're really targeting expectant families as they're expecting their baby. And what we know is that we want to educate expectant moms about that importance of hearing screening, of hearing to their baby's development, knowing the status of their baby's hearing. So the other part that we want to do is we want to make sure that we're following up that parents know what to do if their baby should fail, to follow up urgently. And so the messages are very simple. Hearing is critical, and this is what parents told us, that if they understood that it was about brain development, that it builds a foundation for learning language and literacy, they've got that, and that was important. But because brain development was so important and hearing is so important to these things, and knowing the status of your baby's hearing, your baby is going to have their hearing screened and you need to know the results of that screening, and you need to follow up urgently, if that baby fails.
We're in this business and we probably think those messages are as easy as breathing to us, aren't they? But to new and expectant families, this is an important message for clear, concise 1, 2, 3 of how we're going to message it. So here is the Starts Hear campaign, one of the things we knew is that parents have hopes and dreams for their babies. And so you'll see that the campaign is based... It's bright, it's colorful, it conveys those messages that we just talked about, but it is also built upon the hopes and dreams that families have for their babies, and how we're messaging them. So here's a little bit, and a overview of the Starts Hear Campaign.

Speaker 5:
Whatever adventures are in store for these precious little ones, it all start here. And yet many new parents aren't even aware their baby's hearing will be screened at birth, let alone what to do if they fail. In fact, a significant number of babies who failed a newborn hearing screening are not getting proper follow up, and that's serious because it means they could be missing out on the important early stages of brain growth. What would it take to reverse this alarming trend? Well, it started with a nonprofit that knows how to listen and an idea that spoke to new moms. Since 2015, Hearing First has been a leader in empowering families of children who are born deaf or hard of hearing. To help babies get the hearing help they need, we had to meet families where they are, so we went to where they live, conducting in-home interviews and surveys across the country.
This research uncovered a key insight. When moms understand how important hearing is for babies brain development, they become highly motivated to take the necessary steps to help their babies have a brighter beach. And from that, an empowering new way talk about babies bearing was born, the future starts here. This theme tapped directly into new parents hopes and dreams for their little ones, breaking through to busy stressed-out moms, getting them to lean in, listen and connect their baby's future to brain development and hearing. To visualize these amazing futures, the campaign show, yes, lots of babies, astronaut babies, firefighter babies, ballerina babies, explorer babies, even punk rock babies. And we reach expecting parents in all kinds of unexpected ways, rolling out our message everywhere, from Baby Center and What To Expect, to YouTube and across social media. To further expand the reach of this important message, we partnered with other trusted organizations and experts in early learning, all driving them to startshear.org, in a more meaningful [inaudible 00:47:10] with a simple actionable message, "Know your baby's hearing test results and what to do if they fail."
The results, well, let's just say they speak for themselves loud and clear. In the first year alone, the campaign earned over 24,000,000 video views, 227,000,000 add views, over 1,000,000 emails sent, and most important expected moms' awareness of the urgency of newborn hearing increased 25%. And the Starts Hear campaign is just getting started, so parents keep dreaming of all the wonderful things your kids can grow up to be. At Hearing First we'll support you every step of the way, to help them blast off to their full potential.

Teresa Caraway:
So that provides an overview. You see, the creative is based on hopes and dreams. So you saw we have Mission to Mars, we had explorer babies, firefighter babies, ballerina babies and even punk rock babies. Of all of those, which one do you think has been the most popular? Anybody want to take a guess?

Speaker 6:
Punk rock.

Teresa Caraway:
Yes. Good for you. Punk rock, yes. And that was the one when the creative chief presented it to me, I'm like, "Ooh, I don't know about that one. Maybe some classical music with a violin, or the pianist, concert pianist." And everyone insisted, "No, it's punk rock." And you know what, and then I had to remember, we were creating this messaging for families in bearing years, not of individuals who were grandmother years. And so we went with punk rock, and I'm glad we listened to our younger... And listened to parents of which ones were resonating with them. All the messages were tested to make sure that they were efficient and all.
So really it's just simple 1, 2, 3. Reach expected moms where they are, with a simple message. And we had to find out where moms hang out. We needed to create a place for them to dig deeper about newborn hearing screening, and that became startshear.org. We also send emails and text reminders about knowing the status of their baby's hearing, and results and paying attention to those hearing results. And you heard that some of those year one campaigns, we're just now entering our fifth year, in a minute I'll show you the cumulative results to date, but one of the things that is important, we had to decide who are we messaging? Who do we want to receive this message? Like I say, it's not the grandmothers, it's not the grandfathers, we needed to hang out with our expectant families and we need to decide who and what age ranges were those expected families. Because we wanted to really make sure that things were resonating and that they could act with urgency.
So we are really talking and communicating with expectant moms, we identified that ages 18 to 39 are the sweet spots we need to look at. We are targeting across and communicating across all 50 states. We determined that a household income of $75,000 a year or less, was where we needed to be targeting, because we wanted to get to maybe perhaps less resource families. We also are targeting a less than high school graduate degree, but also through college. And we also wanted to make sure that we were communicating well with Caucasian, African American, Hispanic, and Asian populations. One of the things, as we tested our messages, we found that with this sweet spot of target audience, it also appealed to individuals that had less education, individuals that even had less household income, and then it also appealed to individuals who have higher education levels, higher socioeconomic. So it determined that our sweet spot, if we hit it here, we would serve and communicate with the most people, and resonate with the most people.
The next thing we had to say is, "Okay, where do expectant moms hang out? Where do they get their information?" When I was having my babies, there was this book called What to Expect When You're Expecting, and that was the Bible of pregnancy. How many of you know about that book? And that's where you got information. Yeah. Today, guess what? It's not a book, it's an app, of course, right? So there's the app, what to Expect When You're Expecting, there is Baby Center and there's The Bump, and between those three apps, over 95% of pregnant women receive their information and go to those apps to know they can learn about their pregnancy and what to expect, and to prepare for their baby's birth. So we knew we created a collaborative relationship with those folks. We also knew we had to look at Google search as parents were searching, we needed to show up on YouTube, Pinterest, Instagram, and Facebook. We needed to place ads in those places, information in those places, and be very strategic about it in terms as we were looking at that.
So we also knew that we had to have a place for people to come and moms to come to find out more information, and that became startshear.org, so that it's very simple. The literacy level is on a third to fourth grade literacy level, it needed to be clean, clear and appeal to new parents so that they can find the information they want. They also can sign up for a reminder to pay attention to their child's hearing results. But most importantly, we realized that this was an opportunity to communicate to 3,600,000 moms across the United States, about the importance of hearing and to pay attention to hearing throughout their child's development, because we also know children have acquired hearing loss. We also know that how important it is for literacy development and for reading and academic development, and the early years are critical for that.
So we felt like we had an opportunity to provide an early learning toolkit about the importance of reading, talking, singing to your baby so that those families can learn how to be brain builders in these early critical years. And that was a critical message, in terms of early learning spaces, to take our message to early learning. So we wanted to benefit all babies, that all families interact with their baby, because we looked at the statistic that even though all families want their baby to learn to read well, do well in school, only about 37% of families start reading to their babies daily. And what do we know? Families who read to their children, share books with their children early, it's the best thing that they can do to improve their child's language abilities and improve their child's reading abilities for the future. A simple thing of reading aloud and sharing books. So our Early Learning Toolkit really emphasizes that and that importance as well.
We also knew that Hearing First's website had to be reorganized a little bit, so that the families would come to the site and answer the questions, they could find the information that they wanted quickly. You heard about our partners, we knew we needed to be in the early... We had more in common with early learning, and we need to look at where are those other organizations, those other places that are communicating with expectant families and where they're expanding their information. And so we selected these individuals as endorsing partners, and they are part of that endorsement. Reach Out and Read, which is a part of the American Academy of Pediatrics, and you can see the others there, the Brazekton Touchpoint Center at Harvard University. All of those were important for us to connect, for them to know about the campaign, because that is a place that even these organizations weren't always aware of the... That babies were having their hearing screened and the importance of it. So what did these 15 second ads look like? What do our ads look like on social media? And this is an example of the type of ad. 15 seconds, and I want you to remember this because you're going to be amazed at how many times these 15-second ads will [inaudible 00:56:25].

Speaker 5:
Whatever amazing things are around the corner, they all start with hearing, because hearing helps your baby's brain develop so they can reach their full potential. If your baby fails, to do more hearing screening, learn what to do at startshear.org.

Teresa Caraway:
So you can probably hear the 1, 2, 3 message in that campaign, in terms of that. So let's look at the numbers. The campaign has been going now for four years, and you can see the four-year results, but I want to focus on the cumulative results, just to go right there. And that is that the ad views, in other words, those 15-second ads, that all the ad views have been looked at, 904,000,000, 904,000,000 times. 940,000,000? What is a Karl? Help me out. You got it there. We have a lot of video views, okay? 900,000 million views of video views. Those fifteen-second ads that I just showed you, that example, there's a couple of them and we'll show you another one in a minute, those have been viewed over 300,000,000 times. And the cumulative hours for viewing 15-second ads, is almost 400,000 hours of 15-second ads added up.
We have emailed and sent emails to 12,700,000 moms, over four years time. There have been 1,700,000 million visitors to the hearingfirst.org website. So each year, as you look at year four results, each year it continues to get better and better and to improve. What we're finding is that the creative and the messaging of the campaign still is resonating with new parents, and part of that is because every nine months we have new parents. So it still continues to resonate, we still make sure that... And watch that and keep an eye on it. One of the things that we've learned, through the campaign, is that access to hearing technology, access to early interventional services, it all begins with awareness, and we have to have parents aware and the importance of newborn hearing screening. We also know that the importance of Hearing Center design, take it straight to the parents, learn from the parents and support the parents, rather than a group of experts sitting around the table deciding what was best for parents.
We knew that we needed to reach audiences where they are and where they hang out. And one of the things that we found is that we have extended our messaging, and we found that we were doing it at 29 days post-birth. And that was too... Moms weren't paying attention as much to those messages at 29 weeks. Why? Because they're still trying to adjust to new baby in their life. But there's something about the four-week mark that the dust settles, the clouds clear, and now parents zero in on information that they're being presented. And so that was an important thing, in terms of how we continue to extend our messages to moms. And we also have been optimizing the campaign. What I mean by that is we've looked at Connect.tv, we've placed ads on Sears Radio, and also we've developed point of care contact cards that are in pediatrician and OB-GYN offices, in states that have higher loss to follow up, lost their documentation.
So we're trying those things and looking at that, and looking at trying to learn to optimize so that we can best support families. And one of the things that we're most excited about is that Baby Center has a whole new website devoted to Hispanic families, called Baby Espanol, and so we've expanded into that and that has been received with wonderful success. You have a QR code, if you'd like to read more, and it will start to your four report, you may do that from your goodie bag as well. But how can you be a part? Repost, retweet, like any Starts Hear posts, and let's raise and help spread awareness. Look at the virtual goodie bag, there's a QR code in your seat on the card, and you can download the Starts Hear report, there's also a one-page handout that you can download and share with families in EHDI programs, that explains newborn hearing screening. So this is appropriate in terms of [inaudible 01:01:15]-

Speaker 5:
From baby sense to giant [inaudible 01:01:17], it all starts here. Because hearing helps with your child's brain develop, so they can blast off to their full potential. If your baby fails the newborn screen, learn what to do at startshear.org.

Teresa Caraway:
So appropriate for anything. So one of the things that... I'd like to go back to the Skywalker family, and this is this family expressing their hopes and their dreams, of what the goal is that they want for their baby.

Speaker 4:
I want him to hear me, that's why we're up here. I don't want my baby to hear, I want to be able to talk to him. I want him to talk to me. I guess two weeks old, we had a baby with hearing aids, for the first year of his life, and our instructions were, he has to wear these every waking moment. Do you want to know how many times a baby does this? And every single time we put them back in.

Jace Wolfe:
What I find fascinating about that video, is that she's recalling events that took place 20 years ago, when her son was identified with hearing differences. And yet, even though it was 20 years ago, you can still hear the angst in her voice, you can still hear that she was overwhelmed in that time period. You can still hear the uncertainty that she had at that time, about what was possible for Jacob. It really probably 20 years ago to her, seemed like mission impossible. But what we know is that, again, if we come together, as EHDI professional, with the families that we serve, it's not mission impossible, it's mission probable. And that's not just one man's opinion, that's not just me talking about anecdotal experiences that I've had, with families like the Skywalkers, the research shows that as well. But to make it mission probable, as soon as we identify what a family's desires and goals are, it has to be all hands on deck. And we all have to be moving forward in the same direction to try to support the families in meeting those goals. And so I'm going to play another video here that shows an update on the Skywalker story as it progresses, as we help with an EHDI program, the Skywalkers try to meet their goals for Jacob.

Speaker 4:
Hi there. Hi. Good job, [inaudible 01:03:57] there. Yes, I heard you.
After Jacob's first cochlea implant was activated, we went and ate lunch at a barbecue restaurant, with Jacob with his newly activated cochlear implants, and we had never seen his reaction before. I mean, we're in a restaurant that's loud with people talking, and he's like, "Huh. Huh." I mean, he's hearing all of these sounds that he's never heard before.

Speaker 7:
I used [inaudible 01:04:31] to Teresa, it's like the [inaudible 01:04:32]. A lot of it that has to do with the early invention from the very beginning. Like I said, when he was born, when we started coming up here, he was, what, a week old?

Speaker 4:
He was diagnosed at 10 days old.

Speaker 6:
Yeah. So within a month we're already starting sound and verbal therapy, and listening skills. And so that just... I know that it helps him, by the time he was ready to start kindergarten, he was already knew everything, that they were teaching in kindergarten. And they're like, "There's nothing more we can teach. He's in kindergarten, but we don't... There's nothing we can teach you because he already knows it." So that's just... With early intervention for that and doing this therapy, it makes him smarter.

Jacob Johnson:
That's okay, [inaudible 01:05:30].

Jace Wolfe:
As an early intervention provider, how proud does that make you? How big of a difference are we making in the lives of the children and the families that we serve? And what's awesome is that Jacob is a superstar, but he's not unique. And if we look at the research, it looks at the outcomes of children with hearing loss. This is one study I love and this is hopefully going to convey a message of hope and to celebrate the success that's possible, with EHDI services today. But 129 children in the [inaudible 01:06:00] Verbal programs, in the UK, 97% of children who participated in the program for two years or more achieved age-appropriate speech and language upon their graduation from that program. So the outcomes that we see with Jacob, they're not unique, they're to be expected if we adhere to the 1-3-6 initiatives, and we support children and their families and the way that they need to be supported, to achieve their goals and dreams, and desires for their child.
Another great study, over 400 children who have cochlear implants, 150 of these children, they received their cochlear implant before 12 months of age. And what you can see, and I love this figure, it's a scatter plot, it shows standard vocabulary scores that were measured in school age entry, as a function of the age of which children received their cochlear implants. And you can see a very clear trend there, that the earlier the child receives his or her cochlear implant, the better their vocabulary scores are upon school age injury. But what's really awesome is that you can see that if you draw a line at the 9 to 10 month mark, you can see almost every single child who received a cochlear implant and they're followed prospectively from that point, they achieve age appropriate vocabulary development upon school age entry.
So it's not mission possible anymore, it's mission probable. And that's true for all children, it's especially true for children who are born with additional disabilities or challenges. We know that unfortunately because sometimes those other disabilities are being addressed really early, that children who don't have as early access to hearing intervention, or intervention for their communication needs, maybe is children without additional disabilities. But we know two things from the research, we know that the earlier we identify and support children who have hearing loss and additional challenges, the better their outcomes. And we know that if we can support them early, then typically they'll do one of two things, they'll achieve age appropriate spoken language abilities, or they'll achieve communication abilities that are commensurate with their nonverbal IQ. But it's all essential again, on identifying and starting early. So I can show you tons and tons of research, data, figures over and over that show the same theme. But I want to just follow up with the Skywalker story again because I think we would all rather see the outcomes of a family than look at these research graphs.

Speaker 4:
It never occurred to me that hearing would be connected to learning how to read. I mean, that never was in my brain because I never even thought that we would have a baby, or... Yeah, so I never had a reason to think about it. But hearing there's a foundation for learning... Anything else.
He was in Boy Scouts, he was in Karate. I mean, going to mainstream school, playing in the band. We were just a typical, every day, normal, busy family raising three kids. The only difference is every morning my boys have to put their cochlear implants on, and then boom, they can hear

Speaker 6:
Jacob's making work, he's very [inaudible 01:09:48]. Been in marching band for high school and college, and valedictorian in high school, he sings at church, gets up when were singing.

Jacob Johnson:
My name's Jacob Johnson and I was born in 2005, and life is normal for me right now. I'm in college at Southeastern Oklahoma State University, studying social studies and education. I spend a lot of time watching TV, watching movies, studying about history or genealogy, and I collect coin. Throughout my life, being deaf has not been my primary concern, I don't even think about it a lot. The only time I think about it's when I have to take off, which is like two seconds out of my day. So it's never bothered me, I feel like I can do what I want.

Teresa Caraway:
All right. So nothing better than hearing it from a family themselves and from Jacob himself, in terms of how he views his life and how he also pursues his dreams. And that's what we're all about, that every child and every family gets to pursue the dreams, that they want for each other. So what can we do to optimize EHDI, to make sure that we're doing 1-3-6? And that is that, if you're here, connect with your EHDI coordinator, state coordinator, and say, "How can I be a part of this? How can I help? How can we put our heads together collaboratively, so that all children receive benefit of newborn hearing screening? How can we make sure that we raise awareness of the importance of the screening, for all babies, 3,600,000 babies? So we want to keep the eye on the prize. We want to help parents identify the hopes and dreams that they have for their baby, and then support them with what it takes for them to reach their desired outcome that they have for their child.
And then we need to be a champion for early, time matters, and we have to continue to beat that drum, and then we encourage you to get involved with Starts Hear. And here's your virtual goody bag, scan those QR code, we've loaded it up with resources for you that you'll hear throughout the conference, from members of the Hearing First and Oberkotter team, and it's loaded with things to help support you in your EHDI practices and early intervention. So one more thing. I know Karl, I know we're behind, but...

Jace Wolfe:
Yeah. We just want to leave you with some Yoda level words of wisdom from the Skywalkers.

Speaker 7:
Enjoy your baby. Enjoy your baby. Don't worry, it'll be okay.

Jacob Johnson:
If I could go back in time when I was a newborn and tell my parents anything, it'll be not worry about it. As they did for me, love your baby still. Deafness does not define you.

Speaker 4:
Hearing him say, "If he could go back in time as a newborn telling his mommy and dad," Who were scared out your minds, "Don't worry about it." That just almost brings tears to my eyes.

Teresa Caraway:
So love your baby and shoot for the moon.

Jace Wolfe:
May the force be with you.

Teresa Caraway:
Let's go have a great conference.

Karl White:
Look at your wristwatch, they finished right on time. So it's mission probable because of all of you. So I hope your heads swimming like mine, swimming with ideas and things we can all do. Each of us needs to do something. You have 20 minutes before the next session starts at 10:05. Remember, if you're making a presentation during the conference, go to the presenter [inaudible 01:14:08] and give your slides [inaudible 01:14:10]. But thank you Teresa and Jace, that was wonderful, a great way to start a conference. And thanks to all of you for being here today.