Table 1 Key interventions based on psychosocial symptom level to improve mental health support for NICU families.
From: From NICU to home: meeting the mental health needs of families after discharge
Clinical practice interventions (psychological symptom level) | Interventional targets | Strategies at discharge from the NICU and beyond |
|---|---|---|
Universal (Low) | Self-care | Educate parents about child development, parenting skills, and caregiver mental and physical wellness • Promote strong emotional attachment between the parent and infant by encouraging skin-to-skin care, supporting breastfeeding, and championing participation in developmentally appropriate care [12, 60, 61] • Create opportunities for the involvement of all parents in the NICU and in discharge planning [1, 16, 62] • Encourage parent well-being by promoting routines for diet, sleep, physical activity, stress management, and setting realistic expectations while in NICU and after discharge [16] • Teach parents to interpret and respond to their child’s signals and recognize their individual strengths and weaknesses while in the NICU and after discharge [27, 60] |
Culturally Competent Education, Policies and Guidelines | Provide access to educational materials and interventions that are culturally inclusive and foster wellness and mental health [59] • Provide discharge education including written materials in the family’s preferred language and assess parent understanding through teach back [32, 33, 60] • Implement policies and guidelines for parent support that are evidence-based, culturally responsive, and developed in collaboration with families [12] • Use varied modes of bias-mitigating education such as simulation-based training, online modules, and case-based discussion for all providers caring infants during NICU stay and in outpatient setting [31, 63] • Consider implementing high-quality, evidence-based educational programs involving parents, such as COPE, Mother-Infant Transaction program (MITP) and FNI, during the NICU stay to promote parent mental health and well-being, [51, 52, 61, 64] with continuation of these programs adapted to meet the evolving needs of the family unit after NICU discharge | |
Discharge Preparation | Educate parents regarding potential psychosocial issues beyond discharge [17, 60, 65] Normalize the need to prioritize parent wellness and mental health support during the transition to home process, and educate families regarding symptoms that require further evaluation [1, 32, 35] • Offer a contact point for parents, schedule follow-up appointments before discharge as indicated, facilitate rooming in and coach parents in providing cares for their infant prior to discharge, and conduct post-discharge follow-up calls to ease the transition home [17, 66, 67] • Counsel parents on what to anticipate for their infant’s development, psychosocial adjustment, and emergency or unexpected situations as they transition home [17] • Connect families with support services, including peer support, early intervention services, lactation support, home health nurses, social work, and mental health support as indicated as part of discharge planning [17, 37] • Provide inclusive access to reliable local, national, and international parent support groups, including diagnosis-specific groups, with access via telephone and virtual support as families transition home [1, 12, 38, 68, 69] • Provide warm hand offs inclusive of psychosocial risks to primary care physician, outpatient social workers, and mental health providers as part of discharge planning with parent permission [1, 16, 17, 37] | |
Interdisciplinary, Inclusive Transition Services | Enact interdisciplinary transition to home services comprising of social workers, family resource specialists, and medical teams [70,71,72] • Pair NICU families and healthcare professionals by background and primary language to promote cultural inclusivity during NICU stay and after discharge for follow up care [70] • Provide education and supportive intervention services under the supervision and guidance of licensed clinical social workers or medical providers during NICU admission and as family transitions home [71] | |
Virtual Care and Electronic Support | Leverage virtual care and electronic support to provide additional layers of support [59, 73] • Provide access to novel smartphone technologies (e.g., NICU2Home App, NeoRaksha) to promote parent self-efficacy as part of discharge planning [74, 75] • Implement parent support via secure texts or emails to increase access for families to additional resources after discharge [30, 76] • Offer follow-up visits via Telehealth for care coordination and medical, feeding, and growth support whenever feasible after discharge [33, 38, 73, 77] | |
Universal Mental Health and Social Risk Screening | Screen all NICU families for mental health symptoms as well as family social risk factors [78] • Evaluate NICU families for emotional distress using validated tools at minimum at AAP-recommended intervals and consider additional time points tailored to individual infant and family needs during NICU admission and after discharge [27, 35, 38] • Continue parent mental health screening facilitated by an interdisciplinary team inclusive of social work or adult psychologists with appropriate referrals as indicated during outpatient NICU follow-up clinic visits [38] • Assess for individualized risk based on social determinants of health and provide support beyond discharge [1, 2, 33, 37, 38, 45, 79] | |
Targeted (Moderate) | Tailored Referral and Treatment for Families with Risk Factors | Train community healthcare providers who support families impacted by the NICU to identify mental health symptoms and risk factors [32] • Develop equity-focused interventions to ensure appropriate outpatient follow up for moderate- and/or high-risk families (e.g., teenage parents, parents with histories of mental health disorders, families with limited access and/or low resources due to socioeconomic status, environment, or community factors, history of interpersonal violence) [80] • Encourage outpatient primary care providers to continue universal assessments of parent mental health symptoms and family-social risk at well visits and referrals for further evaluation with specialty services inclusive of mental health professionals, adult primary care, obstetricians, and/or early childhood mental health clinics particularly when there are parent-infant attachment concerns [1, 35, 37] |
Clinical (High) | Perinatal Psychosocial Therapies | Facilitate access to mental health therapies [41] • Connect families with clinically significant symptoms and high risk factors with mental health referrals which may include evidence-based perinatal and postnatal parent mental health interventions such as CBT, trauma-focused CBT, group therapy, couples or family therapy, short-term dynamic therapy, mindfulness training, IPT, and infant-parent mental health and dyadic therapies such as the Parent-Child Interaction Therapy (PCIT), which may reduce parent stress and promote bonding [35, 38, 46, 53, 54, 81,82,83,84,85,86] • Ensure comprehensive care coordination to avoid disruption in psychosocial support during transitions home or to other units [1] |
