Evidence-based assessment/NICU

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EBA in the Neonatal Intensive Care Unit (NICU)

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The 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.