Possibilities and power during early Head Start Home visits: Comparing family- and home visitor-opened decision-making.

Decision-making by families and professionals about how to support children's development is an integral aspect of home visits. This study investigated home visit decision-making in a US program for families experiencing poverty, Early Head Start (EHS), through the following questions: What types of decisions do home visitors and families make about children's development during EHS home visits? How and to what extent do home visitors and families participate during these decisions? A convergent mixed methods research design was implemented to investigate participation through frequency counts and discourse analysis of home visit transcripts. Home visitor participants were four women, three white and one Black. Twelve families participated (12 mothers, 2 fathers). Parents identified as white (n = 8), Black (n = 3), and multiracial (n = 3; Black and white). One parent was a bilingual Arabic and English speaker. A total of 66 decisions about children's development were identified, with 49 decisions initiated by home visitors and 17 initiated by families. Although families talked more and took on active roles when they initiated (i.e., opened) decisions, home visitors predominantly controlled decision-making. Quantitative and qualitative participation differed only in the beginning of family-opened decisions, and home visitors gradually took more control.

La toma de decisiones por parte de familias y profesionales acerca de cómo apoyar el desarrollo de los niños es un aspecto integral de las visitas a casa. Este estudio investigó la decisión de hacer visitas a casa en el programa de Estados Unidos para familias que viven en pobreza, "De un comienzo temprano" (Early Head Start), a través de las siguientes preguntas: ¿Qué tipo de decisiones toman las visitadoras a casa y las familias acerca del desarrollo de los niños durante las visitas a casa del programa "De un comienzo temprano?" ¿Cómo y hasta qué punto las visitadoras a casa y las familias participan durante la toma de estas decisiones? Se implementó un diseño convergente mixto de métodos de investigación para investigar la participación por medio de conteos frecuentes y análisis de las transcritas conversaciones de la visita a casa. Las visitadoras a casa que participaron fueron cuatro mujeres, tres blancas y una de raza negra. Doce familias participaron (12 mamás, 2 papás). Los progenitores se identificaron como blancos (n = 8), negros (n = 3) y multirraciales (n = 3, negros y blancos). Uno de los progenitores era hablante bilingüe de árabe e inglés. Se identificó un total de 66 decisiones acerca del desarrollo de los niños, de las cuales 49 fueron iniciadas por las visitadoras a casa y 17 por las familias. Aunque las familias hablaron más y asumieron un papel activo cuando hablaban primero sobre las decisiones (v.g., cuando abrían la conversación), las visitadoras a casa predominantemente controlaron la toma de decisiones. La participación cuantitativa y cualitativa difirió sólo al principio de las decisiones iniciadas por las familias y las visitadoras a casa gradualmente asumieron mayor control.

Maternal mental health after infant discharge: a quasi-experimental clinical trial of family integrated care versus family-centered care for preterm infants in U.S. NICUs.

BACKGROUND: Involvement in caregiving and tailored support services may reduce the risk of mental health symptoms for mothers after their preterm infant's neonatal intensive care unit (NICU) discharge. We aimed to compare Family-Centered Care (FCC) with mobile-enhanced Family-Integrated Care (mFICare) on post-discharge maternal mental health symptoms. METHOD: This quasi-experimental study enrolled preterm infant (≤ 33 weeks)/parent dyads from three NICUs into sequential cohorts: FCC or mFICare. We analyzed post-discharge symptoms of perinatal post-traumatic stress disorder (PTSD) and depression using intention-to-treat and per protocol approaches. RESULTS: 178 mothers (89 FCC; 89 mFICare) completed measures. We found no main effect of group assignment. We found an interaction between group and stress, indicating fewer PTSD and depression symptoms among mothers who had higher NICU-related stress and received mFICare, compared with mothers who had high stress and received FCC (PTSD: interaction ß=-1.18, 95% CI: -2.10, -0.26; depression: interaction ß=-0.76, 95% CI: -1.53, 0.006). Per protocol analyses of mFICare components suggested fewer PTSD and depression symptoms among mothers who had higher NICU stress scores and participated in clinical team rounds and/or group classes, compared with mothers who had high stress and did not participate in rounds or classes. CONCLUSION: Overall, post-discharge maternal mental health symptoms did not differ between the mFICare and FCC groups. However, for mothers with high levels of stress during the NICU stay, mFICare was associated with fewer post-discharge PTSD and depression symptoms.

Neonatal outcomes from a quasi-experimental clinical trial of Family Integrated Care versus Family-Centered Care for preterm infants in U.S. NICUs.

BACKGROUND: Family Integrated Care (FICare) benefits preterm infants compared with Family-Centered Care (FCC), but research is lacking in United States (US) Neonatal Intensive Care Units (NICUs). The outcomes for infants of implementing FICare in the US are unknown given differences in parental leave benefits and health care delivery between the US and other countries where FICare is used. We compared preterm weight and discharge outcomes between FCC and mobile-enhanced FICare (mFICare) in the US. METHODS: In this quasi-experimental study, we enrolled preterm infant (≤ 33 weeks)/parent dyads from 3 NICUs into sequential cohorts: FCC or mFICare. Our primary outcome was 21-day change in weight z-scores. Our secondary outcomes were nosocomial infection, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and human milk feeding (HMF) at discharge. We used intention-to-treat analyses to examine the effect of the FCC and mFICare models overall and per protocol analyses to examine the effects of the mFICare intervention components. FINDINGS: 253 infant/parent dyads participated (141 FCC; 112 mFICare). There were no parent-related adverse events in either group. In intention-to-treat analyses, we found no group differences in weight, ROP, BPD or HMF. The FCC cohort had 2.6-times (95% CI: 1.0, 6.7) higher odds of nosocomial infection than the mFICare cohort. In per-protocol analyses, we found that infants whose parents did not receive parent mentoring or participate in rounds lost more weight relative to age-based norms (group-difference=-0.128, CI: -0.227, -0.030; group-difference=-0.084, CI: -0.154, -0.015, respectively). Infants whose parents did not participate in rounds or group education had 2.9-times (CI: 1.0, 9.1) and 3.8-times (CI: 1.2, 14.3) higher odds of nosocomial infection, respectively. CONCLUSION: We found indications that mFICare may have direct benefits on infant outcomes such as weight gain and nosocomial infection. Future studies using implementation science designs are needed to optimize intervention delivery and determine acute and long-term infant and family outcomes. CLINICAL TRIAL REGISTRATION: NCT03418870 01/02/2018.

Interprofessional Collaborative Practice in Early Intervention.

Professionals in pediatric practice encounter infants and toddlers with developmental delays, disabilities, or complex chronic health conditions eligible for Part C early intervention (EI) services. The most frequently identified concern by families is communication emphasizing the importance of the role of the speech language pathologist (SLP). This article provides a conceptual framework for SLP services in early intervention, based on the principles of interprofessional collaboration. The history of collaboration, EI, and the role of SLPs as members of the EI team are summarized. The competencies mandated for interprofessional education and practice are juxtaposed with the principles of EI and guidelines for SLPs.