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Recommendations for Program Standards for Psychosocial Support of NICU Parents

Friday, October 23, 2015
Independence Ballroom (Marriott Marquis)
Sue L. Hall, MSW, MD, St. John's Regional Medical Center, Oxnard, CA, Michael Hynan, Ph.D., University of Wisconsin, Milwaukee, WI, Cris Glick, MD, Mississippi Lactation Services, Jackson, MS, Tawna Burton, Intermountain Medical Center, Salt Lake City, UT, Janet Press, BSN, Crouse Hospital, Syracuse, NY, Erika Goyer, BA, Hand to Hold, Austin, TX, Raylene M. Phillips, MD, IBCLC, Division of Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA and Keira Sorrells, BA, Preemie Parent Alliance, Jackson, MS

Purpose

Parents of NICU infants face multiple stresses, and they have higher one-year prevalence rates of postpartum depression and posttraumatic stress disorder (PTSD) than parents of healthy term infants. Stressed parents are less able to form secure attachments with their infants. Premature infants whose parents are depressed have worse developmental outcomes than do other infants.  Therefore, psychosocial support of NICU parents is essential to optimize outcomes for babies.

Methods

The National Perinatal Association convened a multidisciplinary workgroup to determine program standards for psychosocial support of NICU parents.  The group of 50 participants from over 20 organizations met at a one-day summit in 2014. The group included psychologists, social workers, neonatologists, a perinatologist, nurses, nurse midwives, occupational therapists, public health workers, and former NICU parents.  The workgroup was divided into 6 teams to focus on:  1-role of mental health professionals; 2-role of peer support; 3-family-centered developmental care; 4-palliative care and bereavement; 5-post-discharge support; and 6-staff education and support.  Teams performed literature searches to determine evidence-based needs of NICU parents as well as best practices. All recommendations were subsequently sent to participating organizations for their review and endorsement.

Results

Recommendations included:  1- NICUs with 20 or more beds should have at least one full-time masters’ level social worker and one full or part-time doctoral level psychologist embedded in the NICU staff.   Their roles can overlap and may include screening of parents for emotional distress, providing clinical services, and performing research.  2-Layered levels of emotional support should include family-centered developmental care and peer-to-peer support in every NICU, mental health professional support for parents displaying acute distress, and referrals to psychologists or psychiatrists for parents who have more concerning risk factors or escalating distress.  3-Peer-to-peer support provided by trained volunteers should be offered to all parents, with in-person support as a best practice.  When possible, support should begin in the antepartum period and be carried through post-discharge.  4-Family-centered developmental care should include parents as partners in the care team, involving them in all rounds. Parents’ active provision of care is endorsed.  5- All health professionals that work with pregnant women and their families should be trained in palliative and bereavement care. 6- Home healthcare workers should be trained to provide psychosocial support to families as part of their services.  7-All NICU staff should receive training on normal/expected responses of parents to a NICU stay, methods of communication and of providing support to parents, and elements of self-care to minimize burnout.

Conclusion

NICU parents typically experience psychological distress, and staff efforts to provide psychosocial support in a variety of ways can mitigate parents’ increased risk for postpartum depression and PTSD, as well as improve the parent-infant bond.  The infant’s development should be optimized as a result.

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