Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive Care Unit: Descriptive Examination

Abstract

Background Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of nondominant cultures and mothers who are socioeconomically disadvantaged, places infants at an extraordinary risk for poor developmental outcomes throughout life. Although receipt of early intervention (EI) is the best single predictor of developmental outcomes among children with and at risk for early developmental delays, mothers and infants with the greatest needs are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are economically disadvantaged from accessing EI. However, the bridge from the NICU to a mobile internet intervention has been virtually unexplored. Objective This study aims to examine progression flow from NICU exit referral to an early mobile internet intervention to increase EI access and promote parent mediation of infant social-emotional and communication development. Methods Three NICUs serving the urban poor in a Midwestern city were provided support in establishing an electronic NICU exit referral mechanism into a randomized controlled trial of a mobile internet intervention for mothers and their infants. Measurement domains to reflect the bridge to service included each crucial gateway required for navigating the path into Part C EI, including referral, screening, assessment, and intervention access. An iterative process was used and documented to facilitate each NICU in establishing an individualized accountability plan for sharing referral materials with mothers before their NICU exit. Subsequent to the referral, progression flow was documented on the basis of a real-time electronic recording of service receipt and contact records. Mother and infant risk characteristics were also assessed. Descriptive analyses were conducted to summarize and characterize each measurement domain. Results NICU referral rates for EI were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (78%) were screened, and of those screened, 51 (76%) were eligible for assessment. Of the 51 assessment-eligible mothers and infants, 35 dyads (69%) completed the assessment and 31 (89%) went on to complete at least one remote coaching intervention session. The dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity. Conclusions The transition from the NICU to home was fraught with missed opportunities for an EI referral. Beyond the referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting the NICU. Stronger NICU referral mechanisms for EI are needed. It may be essential to initiate mobile interventions before exiting the NICU for maintaining post-NICU contact with some mothers. In contrast to a closed, single point of referral gatekeeper systems in NICUs, open, shared referral gating systems may be less stymied by individual service provider biases and disruptions.

Maternal education and cognitive development in 15 European very-preterm birth cohorts from the RECAP Preterm platform

“…The neonatal hospitalisation may represent a key window of opportunity for addressing social disparities by reducing financial barriers affecting parental presence, 62 promoting breastfeeding, 62 and facilitating access to follow-up and early intervention programmes. 63 Study designs that integrate information on the families' social circumstances would ensure that research on the effectiveness of interventions targets health and developmental disparities.…”

Designing a Mobile Health Solution to Facilitate the Transition from NICU to Home: A Qualitative Study

“…In regards to accessing community-based services, the providers in our study identified completion of referral to early intervention as an important element of information provision for parents which was consistent with previous findings [ 19 ]. In their investigation of possible internet-based interventions for ensuring prompt connection to early intervention (EI) services, Baggett et al found that the “most common reason for mothers and their infants to fall off the path toward intervention was that they could not be contacted after leaving the NICU” [ 20 ]. Parent and provider preferences from our study suggest that, by providing information and referral updates for EI services through a mobile app, the concern for missed referrals in this vulnerable patient population could be improved upon.…”

Pre-intervention child maltreatment risks, intervention engagement, and effects on child maltreatment risk within an RCT of MHealth and parenting intervention

“…Moreover, historical experiences of harm within medical and mental health systems have yielded high levels of distrust ( 19 ). Consequently, extreme inequities have resulted in minoritized populations, who are most in need of support being least likely to access and engage in them ( 23 , 24 ).…”