State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the newborn hearing screening area, a total of 293 items were listed by 49 EHDI coordinators, and themes were identified within each SWOT category. A threats, opportunities, weaknesses, and strengths, or TOWS, analysis yielded 12 recommendations that focused on similar themes. Out of these 12 recommendations, 3 distinct strategies emerged. States are encouraged to: 1) enhance existing screening practices by requiring systematic data collection, reporting, and automation as well as integration of universal newborn hearing screening database systems with other public health initiatives; 2) leverage existing state legislative support to update and expand current universal newborn hearing screening policies and garner increased resources (i.e., personnel and funding); and 3) reduce loss to follow-up by integrating and centralizing data collection and tracking among various agencies and addressing the screening needs of special populations (e.g., home births, non-native English speaking families, religious and cultural minorities). Addressed appropriately, these recommendations can substantially strengthen newborn hearing screening efforts in state EHDI programs. (Contains 6 tables.)