Because newborn hearing screening has become the standard of care in the United States, every state has established an early hearing detection and intervention (EHDI) program responsible for establishing, maintaining, and improving the system of services needed to serve children with hearing loss and their families. While significant developments have occurred in the last 20 years, challenges to newborn hearing screening, follow up, and early intervention still exist. In 2009, the National Center for Hearing and Assessment Management (NCHAM) initiated a national strategic planning activity to help EHDI program coordinators identify ways to improve their programs through the use of a strengths, weaknesses, opportunities, and threats (SWOT) analysis framework. A SWOT analysis, and subsequent threats, opportunities, weaknesses, and strengths (TOWS) matrix analysis, are commonly used methods of strategic planning. This article summarizes the history and status of EHDI programs to provide a context for the strategic planning process, and explains the methodology used in completing the SWOT analysis. (Contains 2 figures and 4 tables.)