Evidence-based assessment/NICU
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EBA in the Neonatal Intensive Care Unit (NICU)
editThe NICU is a stressful place for families, and also for the care providers. There are a lot of sources of stress, and the environment contributes to high levels of anxiety, depression, acute stress, and trauma in parents and providers, as well as a lot of burn-out.
The setting would be an excellent place to offer more free and fast mental health assessment and support tools. The challenges are that this is a fast paced setting, with other major health issues confronting the infant (by definition).
Here is a table offering some suggestions about how the EBA model we are describing here might be adapted to be helpful in the NICU -- both for caregivers and for providers.
Twelve steps in implementing Evidence-Based Assessment, with suggestions for adaptation for the NICU
| Assessment Step | Suggestions for Doing in NICU |
| Preparatory Work Before Seeing Patient | |
| A. Plan for most common issues | Have screening tools and tip sheets for anxiety, depression, acute stress disorder (both parent- and staff-facing); burnout |
| B. Benchmark base rates for issues | Benchmark local rates against prior years, regional and national data, and/or published estimates |
| Admission (“Prediction Phase”) | |
| C. Evaluate risk and protective factors | Make short checklist of key risk, protective factors to improve consistency and coverage |
| D. Revise probabilities based on intake assessments | Have cheat sheet with updated probabilities based on screening results and suggested language for follow-up. (Well-supported staff could use free online calculators, nomograms, more traditional Evidence-Based Medicine.) |
| E. Gather collateral, cross-informant perspectives | Assess partner or co-parent when possible, and share psychoeducational resources (infographics, tip sheets, online tools). |
| Targeted Follow-Up (“Prescription Phase”) | |
| F. Add focused, incremental assessments | If using ultra-brief screeners, have full-length assessments ready for follow-up. Family can do quickly while on unit, or from home. Often same tool can used as Patient Reported Outcome (PRO). |
| G. Brief structured interviews | Have short, structured interviews for common mental health issues (e.g., PRIME-MD, DIAMOND) and orient staff to using anxiety, mood, trauma modules. |
| H. Case re-formulation and goal-setting | If findings suggest mental health issue, provide referral options, psychoeducational resources. |
| X. Learn and use client preferences | Discuss options and risks and benefits; address common concerns or misconceptions, problem solve around barriers |
| Monitoring and Discharge (“Process Phase”) | |
| I. Goal setting: Milestones and outcomes | Have “cheat sheet” with Minimally Important Difference (MID) and benchmarks for significant worsening or improvement on PRO (Step F) |
| J. Progress tracking | Can repeat PRO (Step F) weekly or at each visit |
| K. Discharge planning | Celebrates gains; and plan for continuity of care and ongoing support for family. Develop list of key indicators, recommendations about next action if starting to worsen. |
Note. Steps use letters instead of numbers to reinforce the idea that there is not a strict order.