When a baby is diagnosed at high risk of cerebral palsy: understanding and meeting parent need

PURPOSE

To explore the experiences and needs of parents with an infant diagnosed at risk of cerebral palsy (CP) and to receive feedback on a new online support program (Parenting Acceptance and Commitment Therapy; PACT).

MATERIALS AND METHODS

Eleven parents from eight family dyads (8 mothers, 3 fathers) with infants under 24 months of age (age range 10-24 months) recently diagnosed as at risk of CP as well as fourteen clinicians participated in this qualitative study through interviews.

RESULTS

Parents reported conflicting emotions and grief. Further, they reported that they wanted honesty, support and normalisation of their experiences from clinicians. Parents pointed to a gap in service delivery in terms of non-pathologising psychological support specific to their needs. Clinicians reported a lack of skills in supporting distressed parents. Parent feedback on PACT was positive, with parents receptive to the online delivery.

CONCLUSIONS

Parents want acceptance without pathologisation, honesty, and flexible support. Clinicians working with children at risk of CP need training in grief awareness and support for their own coping. Health services should consider building better parental support into their systems of care.IMPLICATIONS FOR REHABILITATIONParents want clinicians to be honest, supportive and to normalise their griefClinicians in rehabilitation would benefit from up-skilling in grief supportParental support should be built into systems of care for children with cerebral palsy.

Psychosocial Support Provided to Parents of Infants in Neonatal Intensive Care Units: An International Survey

OBJECTIVE

To describe current psychosocial support practices and programs for parents with infants in level II nurseries and level III neonatal intensive care units (NICUs) across Australia and New Zealand.

STUDY DESIGN

A staff member from each level II and level III hospital completed an online survey about the psychosocial support services available for parents in Australia and New Zealand. Mixed methods (descriptive and statistical analysis; descriptive content analysis) were used to describe current services and practices.

RESULTS

Of 66 eligible units, 44 participated in the survey (67%). Hospital-based pediatricians (32%) and clinical directors (32%) were the most common respondents. Level III NICUs reported providing significantly more services for parents than level II nurseries (median [IQR]: level III, 7 [5.25-8.75]; level II, 4.5 [3.25-5]; P < .001), with variability in the type and number of services available (range, 4-13). Less than half of units (43%) reported using standardized screening tools to assess parents for mental health distress, and just 4 units (9%) provided staff-led parent mental health support programs. In qualitative feedback, respondents frequently reported a lack of resources (staffing, funding, and training) to support parents.

CONCLUSIONS

Despite the well-documented distress that parents with infants in neonatal units experience and the evidence-based practices known to reduce this distress, this study identifies significant gaps in parent support services in level II and level III NICUs across Australia and New Zealand.

The importance of assessing parent stress in families with children with severe neuromotor and intellectual disability - a pilot study

Parent-related stress represents the level of dysfunction in the parent-child system related to the parents' functioning. The aim of this retrospective pilot study was to assess the degree of stress perceived by mothers and fathers, in the framework of a family-centred approach to rehabilitation.We considered 43 parents of 29 children with cerebral palsy, genetic disorders or brain injury admitted to a neurological rehabilitation center. Parenting stress was assessed with the Parenting Stress Index - Short Form (PSI-SF) self-report questionnaire and a semi-structured investigation of situational stress factors of the family. The cognitive and motor disability of the children were assessed with the Diagnostic and Statistical Manual of Mental Disorders 5(DSM-5) and the Gross Motor Function Classification System-(GMFCS), respectively.The results showed that parental stress is directly correlated with the level of cognitive and behavioral disability and not with motor disability. No significant difference was found in the level of stress perceived by mothers and fathers. The effect of a worsening occupational situation seemed to influence the perception of stress more than a change in the formal relationship of the couple, but neither was statistically significant.

Psychological impact of neonatal intensive care unit admissions on parents: A regional perspective

OBJECTIVE

This study aimed to report the prevalence of adverse psychological symptoms and health behaviours of parents who had a baby admitted to a regional neonatal intensive care unit to spotlight mental health care in these unique settings.

DESIGN

This was a prospective, prevalence-based study using quantitative data.

SETTING

The study was conducted at the Townsville University Hospital, Queensland.

PARTICIPANTS

Participants comprised 114 parents of 79 infants enrolled in the study (mothers = 69 and fathers = 45).

MAIN OUTCOME MEASURES

Trauma, depression, anxiety, stress, alcohol and drug use, prior mental health history and bonding experience were assessed by standardised self-report questionnaires and a structured diagnostic interview within 2 weeks and at 3 months post-admission to neonatal intensive care unit.

RESULTS

Clinically significant acute trauma symptoms (16% of mothers only), depression (22% mothers; 4% of fathers), anxiety (27% mothers; 11% fathers) and stress (24% mothers; 13% fathers) were reported within the first 2 weeks after their baby was admitted to the neonatal intensive care unit. Notably, 18% of parents reported engaging in harmful alcohol use behaviour within 2 weeks post-birth; 29% of fathers continued to report risky drinking at 3 months. At 3 months, 21%, 8% and 6% of mothers met diagnostic criteria for generalised anxiety disorder, major depressive disorder and post-traumatic stress disorder, respectively.

CONCLUSION

Screening for psychological distress and alcohol use of parents of neonatal intensive care unit babies can ensure that support services are made available post-discharge to optimise family function and development of the preterm infant.

Caring for our caretakers: building resiliency in NICU parents and staff

The neonatal intensive care unit (NICU) is a high-acuity, stressful unit for both parents and staff. Up to 50% of mothers and partners experience emotional distress (i.e., depression, anxiety, or posttraumatic stress) during NICU hospitalization and 30-60% continue to experience distress after discharge. Similarly, up to 50% of NICU staff report burnout and emotional distress. Although healthcare providers have developed interdisciplinary guidelines to enhance psychosocial resources for parents and staff, standardized psychosocial services are lacking. The purpose of this short communication is to describe: (1) the need for psychosocial interventions for NICU parents and staff; (2) existent psychosocial programs and their gaps and limitations; and (3) future directions for psychosocial care in NICU settings. We reviewed the current literature and propose a new conceptual model to inform psychosocial interventions for the NICU. We argue that brief, evidence-based, resiliency, and relationship-based programs are needed to enhance parent and staff outcomes and, ultimately, child development and the NICU unit culture.

CONCLUSION

Given the lack of standardized psychosocial care, new interventions for NICU families and staff are needed more than ever. Resiliency, relationship-based interventions that leverage multidisciplinary support may be an innovative way to enhance NICU outcomes and care.

WHAT IS KNOWN

• 40-50% of parents in the NICU report elevated emotional distress and 30-50% of staff report burnout. • Psychosocial interventions for parents and staff are needed, yet lacking.

WHAT IS NEW

• Interventions that focus on resiliency and relationships may improve the culture of the NICU. • New multidisciplinary collaborations and approaches are needed to improve implementation.

Early developmental screening and intervention for high-risk neonates - From research to clinical benefits

With advances in neonatal care there has been an increase in survival rates for infants born very preterm and/or with complex needs, such as those who require major surgery, who may not have survived decades ago. Despite advances in survival, these infants remain at high-risk for a range of neurodevelopmental delays and/or impairments including motor, cognitive and emotional/behavioural challenges. Research has improved our ability to identify which infants are at high-risk of developmental delay and/or impairments, and there is mounting evidence that early interventions can improve outcomes of these infants. However, clinical practice varies throughout the world regarding recommendations for developmental screening. Moreover, intervention, when available, is often not commenced early enough in development. Given limited resources, those infants most at risk of developmental impairments and their families should be targeted, with further research needed on the cost-effectiveness of surveillance and early interventions.

Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health

Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.

Early Parenting Acceptance and Commitment Therapy 'Early PACT' for parents of infants with cerebral palsy: a study protocol of a randomised controlled trial

INTRODUCTION

New international clinical practice guidelines exist for identifying infants at high risk of cerebral palsy (CP) earlier: between 12 to 24 weeks corrected age, significantly earlier than previous diagnosis windows in Australia at 19 months. The earlier detection of infants at high risk of CP creates an opportunity for earlier intervention. The quality of the parent-infant relationship impacts various child outcomes, and is leveraged in other forms of intervention. This paper presents the protocol of a randomised controlled trial of an online parent support programme, Early Parenting Acceptance and Commitment Therapy (Early PACT) for families of infants identified as at high risk of CP. We predict that participating in the Early PACT programme will be associated with improvements in the parent-infant relationship, in parent mental health and well-being as well as infant behaviour and quality of life.

METHODS AND ANALYSIS

This study aims to recruit 60 parents of infants (0 to 2 years old corrected age) diagnosed with CP or identified as at high risk of having CP. Participants will be randomly allocated to one of two groups: Early PACT or waitlist control (1:1). Early PACT is an online parent support programme grounded in Acceptance and Commitment Therapy (ACT). It is delivered as a course on an open source course management system called edX. Early PACT is designed to support parental adjustment and parent-infant relationship around the time of early diagnosis. Assessments will be conducted at baseline, following completion of Early PACT and at 6-month follow-up (retention). The primary outcome will be the quality of parent-child interactions as measured by the Emotional Availability Scale. Standard analysis methods for randomised controlled trial will be used to make comparisons between the two groups (Early PACT and waitlist control). Retention of effects will be examined at 6-month follow-up.

ETHICS AND DISSEMINATION

This study is approved through appropriate Australian and New Zealand ethics committees (see in text) with parents providing written informed consent. Findings from this trial will be disseminated through peer-reviewed journal publications and conference presentations.

TRIAL REGISTRATION DETAILS

This trial has been prospectively registered on 12 June 2018 to present (ongoing) with the Australian New Zealand Clinical Trials Registry (ACTRN12618000986279); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=3 74 896.