As neonatal therapists, one of the essential components of an inpatient therapy program, specifically in the NICU, is preparing infants and families for the transition home. While there are published standards for the medical transition home by the American Academy of Pediatrics,1 and the National Perinatal Association,2, there is a lack of defined research on the key principles of effective NICU-to-home therapist-supported interventions.3 A recent Delphi study by Miller initiated closing this gap by establishing four key principles for therapist-supported interventions during the NICU-to-home transition: building caregiver-child relationships, optimizing infant development, sharing education and knowledge, and creating enriched environments.3 By integrating these principles with current evidence, neonatal therapists can better support families on the road to discharge.
What we DO know from the research about “Going Home”
- Consistent information is key.
Providing parents with consistent and timely information throughout their hospital stay is a vital part of discharge preparation.4 Despite this, parents and caregivers report a lack of continuity and communication, especially when there are turnovers in the care team. 4,5 Lakshmanan et al found that in general, families indicated a need for more knowledge and clear, consistent information.6
- Parental stress and anxiety are common.
Parents of infants who have been in the NICU experience additional anxiety and stress related to preparedness for discharge home.7,8 However, educational interventions, particularly those that focus on understanding infant cues, have been shown to reduce parental anxiety and improve readiness.7,9
- “Early Intervention” is not always “Early.”
Preparing and referring the family to early intervention services post-discharge is standard care for premature and medically complex infants. Yet despite legal requirements for early intervention services, infants often experience delays in initiation or fail to receive services entirely.6,10,11,12
Building on these research findings and the proposed key principles from the Miller study, consider some areas where neonatal therapists can positively impact the transition home.
1. Advocate for consistent, evidence-based information.
Inconsistent communication is one of the biggest challenges families face. Therapists can advocate for standardized education programs such as the Infant-Driven Feeding® Program, or the SENSE® Program.13,14 Programs such as these provide staff with a common language to share with one another and with parents, while also establishing consistent practices. Consistent education and practice reduce confusion and build trust.
If new education is introduced, consider leading a Quality Improvement (QI) project. Pre- and post-intervention parent surveys can help determine whether the implemented plan improves parent understanding and satisfaction.
2. Make cue-based education a primary focus.
Supporting caregiver-child relationships and knowledge sharing begins with helping parents understand their baby’s cues. Dr. Heidi Als, the originator of the Synactive Theory, and the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), laid the groundwork for our current practice, so that we can help parents understand how each infant communicates through behaviors or “cues”. By teaching parents to interpret and respond to these cues, we support each infant’s strengths and their self-regulation, while helping parents provide daily nurturance.15
A systematic review by Springer et al from Cincinnati Children’s Hospital found that utilizing repeated hands-on practice – such as guided opportunities to read infant cues and provide direct care (bathing, feeding, massage, kangaroo care)- leads to increased parental satisfaction, confidence, and preparedness for discharge, along with improved carryover of skills to the home setting.7
Particularly regarding oral feeding, success is closely tied to the caregiver’s ability to understand and respond to the infant’s cues. This also improves parent satisfaction. Studies have found that implementing the Infant-Driven Feeding® Program, which focuses on infant cues and has a parent education component, improves parent satisfaction.16,17,18
3. Construct bridges to early intervention.
Begin discussion and education on follow-up services early and investigate opportunities for a “bridge” program. Studies have documented that a successful transition to EI can start before discharge. In fact, some programs, such as the Baby Bridge program, have the early intervention team connect with the family and collaborate with the hospital team while the family is in the NICU.12 Studies have shown that bridge programs result in improved early intervention visit rates,6 earlier initiation of services, and more infants receiving services.12
The neonatal therapist’s role in the NICU-to-home transition continues to evolve and requires further research. While we cannot address every transition challenge, we can effect meaningful change through focused family-integrated interventions, one family and one step at a time.
For more information about the Infant-Driven Feeding® Program, contact Dr. Brown’s Medical at [email protected].
View a recorded webinar on this topic: Homeward Bound: Supporting Infants and Families from the NICU to Home Here:
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