JMIR Publications

ABSTRACT

Background:

Neonatal intensive care unit (NICU) history, combined with systemic inequities for mothers of non-dominant culture and mothers who are socioeconomically disadvantaged, places infants at 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 at highest need are least likely to receive EI. Mobile internet-based interventions afford substantial advantages for overcoming logistical challenges that often prevent mothers who are econnomiclly disadvantaged from accessing EI. However, the bridge from NICU into mobile internet intervention has been virtually unexplored.

Objective:

To inform efforts for increasing EI access, the objective of this manuscript is to examine progression flow from NICU exit referral into early mobile internet intervention promoting 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 prior to NICU exit. Subsequent to referral, progression flow was documented based on 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 early intervention were 3 to 4 times higher for open-shared versus closed-single gatekeeper referral processes. Of 86 referred dyads, 67 (77.91%) were screened and of those screened, 51 (76.12 %) were assessment eligible. Of 51 assessment eligible mothers and infants, 35 dyads (68.63%) completed assessment and 31 (88.57%) went on to complete at least one remote coaching intervention session. Dyads who accessed and engaged in intervention were racially and ethnically diverse and experiencing substantial adversity.

Conclusions:

The transition from NICU to home was fraught with missed opportunities for EI referral. Beyond referral, the most prominent reason for not participating in screening was that mothers could not be located after exiting NICU. Establishing stronger NICU referral mechanisms to EI are needed. Additionally, initiating mobile interventions prior to NICU exit may be necessary for maintaining post NICU contact with some mothers. In contrast to closed, single point of referral gatekeeper systems in NICUs, cpen, shared referral gating sytems may be less stymied by individual service provider biases and disruptions Clinical Trial: Grant was issued prior to NIH trial registration