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Understanding the Steps Toward Mobile Early Intervention for Mothers and Their Infants Exiting the Neonatal Intensive
Kathleen M Baggett1, Betsy Davis2, Susan H Landry3
1Mark Chaffin Center for Healthy Development, School of Public Health, Georgia State Universtiy, Atlanta, GA, United States.
Journal of Medical Internet Research
|September 22, 2020
Summary
Mobile interventions can improve early intervention (EI) access for high-need infants exiting the neonatal intensive care unit (NICU). Open referral systems in the NICU enhance EI access, connecting vulnerable mothers and infants to crucial developmental support.
Area of Science:
- Neonatal care and developmental pediatrics
- Public health and health equity
- Digital health interventions
Background:
- Infants with neonatal intensive care unit (NICU) histories face heightened risks for developmental delays, particularly those from disadvantaged or minority cultural backgrounds.
- Early intervention (EI) is critical for developmental outcomes, yet access is limited for mothers and infants with the greatest needs.
- Mobile internet interventions offer a promising solution to overcome logistical barriers to EI access for economically disadvantaged mothers.
Purpose of the Study:
- To investigate the effectiveness of transitioning NICU patients to a mobile internet-based early intervention program.
- To enhance EI access and support parent mediation of infant social-emotional and communication development.
Main Methods:
- Three urban NICUs serving disadvantaged populations implemented electronic referral systems to a mobile EI intervention trial.
- The study tracked progression through referral, screening, assessment, and intervention access using real-time electronic records.
- Iterative process improvement and individualized accountability plans were used to optimize NICU referral mechanisms.
Main Results:
- Open-shared NICU referral processes yielded 3-4 times higher EI referral rates compared to closed systems.
- Of 86 referred dyads, 78% were screened, 76% of those were eligible for assessment, and 69% completed assessment.
- 31 dyads (89% of those assessed) engaged in remote coaching, representing a diverse group facing significant adversity.
Conclusions:
- Significant opportunities for EI referrals are missed during NICU transitions, with difficulty locating mothers post-discharge being a major barrier.
- Enhanced NICU referral mechanisms are essential, potentially including pre-NICU exit mobile intervention initiation to maintain contact.
- Open, shared referral systems appear more effective and less susceptible to disruptions than closed, single-gatekeeper models.
