Neonatal therapy: A survey of current practice

Abstract

BACKGROUND: Although considered an advanced area of practice, there has been insufficient standardization in clinical training and preparedness for occupational therapists (OTs), physical therapists (PTs), and speech-language pathologists (SLPs) practicing in the neonatal intensive care unit (NICU). The first step in developing a neonatal therapy certification process was to conduct a practice analysis. PURPOSE: To describe: 1) the collection of OTs, PTs, and SLPs working in NICUs, 2) educational and professional preparation to practice in the NICU, and 3) interest in neonatal therapy national certification. METHODS: An online survey of 468 neonatal therapists was completed in 2015-2016. RESULTS: There were 208 (47%) participants who were OTs, 140 (32%) PTs, and 94 (21%) SLPs. Among respondents, 187 (50%) neonatal therapists had a clinical doctorate, and 143 (40%) therapists practiced for > 5 years prior to entering NICU practice. There were 299 (88%) therapists who believed oversight and accountability in the NICU are highly important, and 329 (98%) therapists were interested in a neonatal therapy certification program. CONCLUSIONS: Advanced training and skills of neonatal therapists are vital to ensure safe, effective and evidence-based practice. Insufficient standardization in training and variable adherence to education and training guidelines provided credibility for the creation of a neonatal therapy national certification process, which has now been implemented.

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

“…Surveys were distributed using a link to a REDCap survey, which was completed from the participant's phone, computer, or tablet and uploaded immediately to a central REDCap database. The survey was intended to improve understanding of current practice in the NICU while defining the skillsets of neonatal therapists and determining the need for a formal process of validation through certification [30].…”

“…While most therapists (OTs, PTs, or SLPs) receive some foundational education on the NICU in educational programs [1,2,24], CNTs are considered advanced clinicians who have demonstrated further experience and knowledge to perform the highly specialized care needed for infants and their families in the NICU [1,2]. This is particularly important, because the foundational knowledge initially learned through a therapist's degree program is suboptimal to work appropriately within a NICU setting [30]. Validation of a team member's knowledge through neonatal therapy certification is a valuable step towards optimizing patient care.…”

“…It appears that hospitals that have more CNTs have more multidisciplinary teams; however, we are unable to demonstrate causation from the data collected. With the welldocumented variability in how neonatal therapists practice in the NICU [2,24], and some therapists only working a few hours per week in the NICU setting, it would be interesting to investigate if CNTs practice more hours per week in the NICU due to their advanced knowledge, and how that consistency impacts clinical outcomes.…”

“…In a 2012 survey, 226 neonatal therapists were identified and assisted in the development of a professional definition of neonatal therapy [12]. In 2016, a survey of 468 neonatal therapists demonstrated the high level of education and training undertaken by neonatal therapists to achieve their role, the belief that oversight is important in their role, and further aided understanding of the distribution of neonatal therapists within NICU settings [2]. A 2020 survey identified at least 1713 neonatal therapists in the United States (US; manuscript in preparation).…”

“…Moreover, there are some areas of therapy service delivery that are considered as advanced practice and require advanced training and skill, going well beyond what is provided in entrylevel training programs for all three disciplines. 2 Neonatal therapy is considered as an advanced area of practice for OTs, PTs, and SLPs, and is recognized as such by all three professional organizations (American Physical Therapy Associa-tion, American Occupational Therapy Association, and American Speech and Hearing Association). [3][4][5][6] Further, the National Association of Neonatal Therapists (NANT) states the following in their Scope of Practice document 7 :…”