Multiple changes and stressors at the family, hospital, and societal levels have resulted from the COVID‐19 pandemic that impact the early social environment of infants in Neonatal Intensive Care Unit (NICU) settings. This manuscript reviews these pandemic‐related adversities, including hospital‐wide visitor restrictions, mask requirements that interfere with caregiver facial expressions, parental anxiety about virus transmission, and reduced support services. We will further describe adaptations to mental health service delivery and approaches to care in the NICU to mitigate increased risk associated with pandemic‐related adversities. Adaptations include integration of technology, staff education and support, and delivery of activity kits to encourage parent–infant bonding. Data was collected as part of routine program evaluation of infant mental health services from one 50‐bed NICU setting and describes family concerns, barriers to visitation, and utilization of mental health services during the pandemic. Concerns related to COVID‐19 rarely emerged as the primary presenting issue by the families referred for infant mental health services from April through December of 2020. However, a number of families indicated that infection concerns and visitation restrictions posed significant challenges to their parenting and/or coping. There were significant discrepancies noted between the visitation patterns of families with public and private insurance. Several adaptations were developed in response to the multiple challenges and threats to infant mental health present during the COVID‐19 pandemic.
Substance use during the perinatal period is a critical public health concern with high potential for negative effects on maternal and infant/early childhood health and well-being. This chapter provides an introduction to the principles of trauma-informed care and highlights the importance of its use as a framework for understanding substance misuse in pregnancy and beyond. Rates, impact, assessment, and treatment of substance use disorders are explored within the context of pregnancy, the neonatal period, and early childhood utilizing an intergenerational life span lens. For families impacted by substance use, it is imperative to utilize collaborative, family-centered, and trauma-informed interventions that incorporate intentional efforts to increase access to appropriate care and reduce stigma and bias across systems to optimize positive outcomes.
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