Babies’ Transition from the NICU to Home: Clarifying Occupational Therapist’s Role in the Process (Phase II)

Sandra Blumenthal, Katherine Hannauer, Mary Ellen Sobo

Faculty Advisor: Brigitte Desport, DPS, OTR/L, BCP, ATP
SUNY Downstate Health Sciences University, School of Health Professions, Occupational Therapy Program

Abstract
• There remains a gap in service delivery at the point of transition from the
neonatal intensive care unit (NICU) to the home regarding the needs of
parents and caregivers
• In the absence of someone to coordinate the flow of discharge
information, parents have reported feeling confused and overwhelmed
during the transition
• Transition to home: the time parents are told they will be taking their
child home, up to the point of returning home and initial days of "settling
in"
• Specific challenges identified in an earlier phase of this research study
included concerns across the domains of feeding, bathing/diapering,
use of medical equipment, and preparation of the home
environment at the time of discharge from the NICU. Additionally, half
of the participants did not receive formal training in the areas of feeding,
bathing, putting baby to sleep, addressing social/emotional needs
and changing diapers/clothing
• Based on these findings, the NICU Transition Contract was developed,
Results Implications for Occupational Therapy
which is intended to serve as a baseline for discussion with a NICU
professional prior to discharge, easing the transition process • The NICU Transition Contract has significant potential to improve the
• Confidence Rating Scale responses of the Contract’s experience of families transitioning to home from the NICU, reducing
Objectives effectiveness were overwhelmingly positive with stress and friction within the family system. This may enhance the
70.5% of these answers "Absolutely" and 24.4% parental-child bond and developmental and health outcomes.
The objectives of this research project were to develop a NICU Transition • OTs are uniquely suited to assist in navigating this complex process,
Contract using data collected from Phase I and to assess the effectiveness "Somewhat” based on the five domains of occupational therapy (occupations; client
of the Contract. Primary sources for this document were the American factors; performance skills; performance patterns; and context and
Academy of Pediatrics and the Centers for Disease Control and Prevention.
• Topics mentioned most frequently as being most helpful environment) and the discipline’s foundation in medical sciences,
Revisions have been made based on the participant interviews. include: Developmental Milestones, Family Support pediatrics, rehabilitation, and mental health. OTs should be principal
players in the transition process, serving to prepare families for logistical
Services, and Safe Sleep hardships, connecting them to support systems, and empowering them
Methods to recognize and advocate for their own needs and those of their babies.
• 6 out of 13 participants felt the Feeding section should
• Study approved by SUNY Downstate Health Sciences University's IRB • By serving as liaison between familial caregivers and NICU staff, OT
• Convenience sampling method used to recruit parents/guardians of be expanded, and provided specific recommendations practitioners advocate not only for their patients and their families, but
babies in the NICU. Sources of Recruitment: also for policy changes that may reduce readmissions and thereby
• University Hospital's NICU follow-up clinic • 5 out of 13 participants recommended expanding the benefit the institution as well.
• Distribution of recruitment flyer Social Emotional and Physical Stimulation section
• SUNY Downstate alumni contacted via email Conclusions
• Recruitment material posted in message boards on AOTA.org • Nearly all (12 of 13) felt that none of the information Occupational therapists are uniquely suited to assist in navigating the
• Screening questionnaire to determine if participants met study criteria provided was unnecessary or redundant complex NICU discharge process and transition home, consolidating
• Confidence rating scale and semi-structured interview: information and connecting parents/guardians to support services needed
• Used to obtain information about parents/guardians experience • 9 out of 13 participants responded positively or neutral to ensure a smooth adjustment. The Contract serves as a mechanism to
taking their babies home from the NICU assist with this process.
• Incorporated quantitative and qualitative questions to the title "NICU Transition Contract"; 4 participants
• Interviews held one-on-two either in person or via phone; one found it too "businesslike" or "formal" References
student researcher conducted interview while other documented Desport, B., Adler, Y., Rarivoson, N., Saca, M., & Sanchez, K. (2019). Babies’ transition from the NICU to home: Clarifying occupational therapist’s role in the process

participant responses • Mobile app was ranked as top choice for delivery of (Unpublished master’s thesis). SUNY Downstate Health Sciences University, Brooklyn, New York.

Berman, L., Raval, M., Ottosen, M., Mackow, A., Cho, M., & Goldin, A. (2019). Parental perspectives on readiness for discharge home after neonatal intensive care
• Responses were analyzed using Qualtrics and Microsoft Excel this information when asked to rank preference of unit admission. The Journal of Pediatrics, 205, 98-104. https://doi.org/10.1016/j.jpeds.2018.08.086

• 18 parents were screened, 13 (all parents) were interviewed Purdy, I.B., Craig, J.W., & Zeanah, P. (2015). NICU discharge planning and beyond: recommendations for parent psychosocial support. Journal of Perinatology, (35),

mobile app, paper document, and in-person class

S24-S28. doi:10.1038/jp.2015.146

• Age range of participants: 23-42 years old (mean age=33.8 years) Smith, V., Dukhovny, D., Zupancic, J., Gates, H., & Pursley, D. (2012). Neonatal intensive care unit discharge preparedness: Primary care implications. Clinical
Pediatrics, 51(5) 454 –461 DOI: 10.1177/0009922811433036