Transcription:
Unconventional Care: How Innovative NICU Programs Support Families and Babies

Deborah Howell: Many factors impact the health and recovery of Le Bonheur's tiniest patients in the neonatal intensive care unit, also known as the nicu. Today we'll hear from just a few of the individuals who've brought unique and innovative NICU programs to support families and babies. Welcome to our panel discussion. Mary Gaston. You're the clinical director of the Neonatal Intensive Care Unit at Le Bonheur. What does it mean to be a NICU clinical?

Mary Gaston: Well, that's a good question. as clinical director of the NICU, I am responsible for the 24 hour, seven day a week overall operations of the unit. So overseeing nurses and our ancillary staff, budgets, all that kind of stuff, just to make sure that our unit is operating at its best and to provide the best quality care we can for our patients and families.

Deborah Howell: Right now, of course, Le Bonheur has expert doctors that care for the medical needs of children. But what are some of the non-medical programs that Lab Bonner's NICU offers to impact the health and wellbeing of patients and their families in the NICU?

Mary Gaston: We have a lot of great and innovative non-medical programs here in the NICU that have recently started over the last couple years. And I'll just name a few, but I'll let the experts talk about them. But we have a fantastic child life team who has done some innovative things over the last couple of years as our babies are older and older in the unit, so we're keeping them longer and longer. So bringing in things like therapy dogs for the children and families. We have a music therapist. We have three wonderful social workers that have done amazing things that have started doing screenings on our parents, mostly mothers, but also our fathers for postpartum depression.

We have a family intervention focus program so that we can identify the needs of the families early on and to be able to help them and provide 'em the resources that they need. most recently we, brought Angel Eye to our NICU and AngelEye is a camera, that is in every room for all our patients where our families, when they're not able to be in the NICU, can see their child. And it brings a lot of comfort and, relief to them to know that their baby's okay.

Deborah Howell: That sounds amazing. Why is it so important to have these programs and how do they benefit patients and families?

Mary Gaston: Well, it's important to have these programs, because our families stay here for a long time in the NICU and we want to be able to normalize, things as much as we can and help them through a very traumatic time in their life. and it benefits. The families because we are being able to find resources to help them, when we can and, help them learn to become a good mom and parent to their baby. it helps our patients. If you have a mom at the bedside or an involved mom, our babies tend to do better.

Deborah Howell: Yeah, no question. Tell us a little bit more about Angel Eye, what is it and how is it brought to Le Bonheur?

Mary Gaston: Sure. So Angel Eye is a camera. it's a company actually called Angel Eye. and it's a camera that's at bedside. and the parents can view their, baby at any time during the day through an app on their phone. They can share it with their family and friends. So that brings them a lot of excitement because not always can, families have visitors up here that, or friends that can come up here and may have never seen their baby. So it lets them talk about their baby to family. we were lucky enough to be able to bring Angel Eye up to Le Bonheur through the donations of, a very generous donor to Le Bonheur.

Deborah Howell: Incredible. Oh my gosh. That donor's made such a difference for so many families. Why did the NICU wanna have Angel Eye technology?

Mary Gaston: Simply, I've actually been on this Angel Eye journey for a while and so, grateful that we had a donor that was able to support this, but there's a lot of anxiety as a new parent and having a baby in the NICU and just being able to see, their baby can really ease that anxiety. It was also so important in the times of visitation restrictions that we have at times, because Covid or sometimes we have to restrict during the flu season or RSV season. So this is just for me, this is another thing that we can do for our families.

Deborah Howell: I love it. What impact have you seen so far of having Angel Eye in the NICU? What has the response been from the parents?

Mary Gaston: The response has been great. They love it. They have shared their app, every state in the United States has kind of covered. It's really interesting to see how many people and how, much has. they've shared throughout the United States, with their family and friends to be able to see their baby. A lot of them said that when they've gone back to work, this has brought really great relief to them and has helped ease their mind. It's had a lot of impact.

Deborah Howell: I'm sure. And how will these kinds of programs continue to evolve in the NICU going forward? Anything else on the horizon?

Mary Gaston: Yeah, we are working with our doctors around this whole idea of helping families. it's a new term that's kind of being used out there, especially in a NICU, but also in ED and other worlds, called Trauma Informed Care. And it's how do you help the whole family understanding what a family has gone through in their life, how you can talk to families better, and just partner with them. And also trauma informed care for anybody that works in the NICU and how do we support each other?

So I think that's the next best thing on the horizon, that I can think of unless Barbara or Ann have something else they, can say, but we're always trying to think outside the box of what we can do better to make our unit better, and what we can do to, help support our staff as well.

Deborah Howell: it sure sounds like it. let's shift our focus toward mental health and welcome Barbara Williams, a social worker with the NICU. Welcome, Barbara.

Barbara Williams: Well, thank you.

Deborah Howell: What is the NICU Perinatal Mental Health Screening Initiative and how does it work?

Barbara Williams: Well, our NICU Perinatal Mental Health Screening was developed because we knew that parents, not just moms, but parents go through a lot of stress when their baby is admitted to the NICU unit. It may be due to, early arrival or anomalies or health problems that is gonna be long-term issues for the parents. So we decided, we talked about this for couple of years before we actually got started, that it may be good to start assessing the parents early on to assess whether or not they need a little bit more involvement from the social workers or from the staff or some additional counseling support.

So what we started doing with the social workers, we, within the first week or two, and sometimes even on it met, we would do an assessment. We use the Edinburgh Postnatal Depression Scale, the Perinatal Anxiety Screening Scale. And it's just, three little short pages where they just choose the appropriate answer for themselves. It just asks questions about how they're feeling, what they're going through. It just takes usually about five or 10 minutes, but it was a way that we could tell where their, where the parents were in their mental health.

Deborah Howell: Perfect. All right. Next question. What interventions are available for parents who need mental health support?

Barbara Williams: Well, usually, if possible, if it's sort of minor issues, the social worker is there to assess what type of support. checking on the parents, just making sure that they're comfortable, that they're understanding what the physicians are saying or what the nurses are saying who are great with our parents. But we've also had brought in our psychologist, Dr. Carlos Torres. He can also meet with the parents and on a regular basis, just to check what other trauma the parents may be going through that also may be triggered due to them having their baby in the neck unit. And sometimes we, even if we know that there's gonna be, like long-term issues that they may experience, we will refer them out for counseling in their neighborhood.

Deborah Howell: Oh, what a wonderful resource. Now, do you know why this initiative?

Barbara Williams: Oh yes. It was started because we knew just based on statistics, that one in seven moms experienced postpartum depression or anxiety when their babies are in the hospital and one in 10 new dads have sometimes the same symptoms. So we knew that it was important to address these issues, and it tends to make the stay a little bit more comfortable for the parents as we go ahead and assess those needs.

Deborah Howell: Sure, because I can imagine that a parent's mental health can impact the health of a NICU baby.

Barbara Williams: Yes, it can. sometimes parents, either they're overwhelmed or they may sometimes withdraw due to the concerns of the child, whether or not the child may make it or what is it gonna be like when I get home. I didn't have my perfect dream baby, so it's a lot.

Deborah Howell: Yeah. Barbara, what kind of results have you seen since you started the program? Are there any changes in how parents interact with their hospitalized baby or improve patient outcomes?

Barbara Williams: Oh, yes, certainly. I would say that we have seen more involvement with the child not being quite as afraid of their child. So it's been very wonderful, especially cuz we really did kick this off right in the beginning of the pandemic. So some of the parents weren't able to have additional as they had in the past. So this was a wonderful way to help our parents, cope while in the NICU.

Deborah Howell: That's great for the families, but what's the feedback from physicians on the program?

Barbara Williams: The feedback is great and what we see a lot of other physicians, sometimes if we're not present at the time when they first meet the parents, they will request the social worker to do, one of the screens on the parents or meet with the parents or even have Dr. Torres to meet with them. So everybody's been on board. The nursing staff, just everybody.

Deborah Howell: Oh, that's terrific, what's the hope for the future of the program?

Barbara Williams: Well, with us continually to grow, I would hope that we would have more social workers, additional, psychological, assistance. Hopefully we will see more parents being able to better with their stay in the NICU, especially for those long stays.

Deborah Howell: Thank you so much, Barbara. Now I have a few questions for Anne Elizabeth Hattier. She's a certified child life specialist for the NICU at Le Bonheur. What is a child life specialist and what's their role in the NICU?

Anne Elizabeth Hattier: Thanks Deborah. So a certified Child Life specialist, is, what we do is we support patients and families, all the psychosocial, components of hospitalization for a patient from birth to 18 years of age. We are well versed in the different stages of development and how, children respond to the hospital environment, including their diagnosis, their sense of autonomy, understanding what's really happening around them, and to them when they don't really have choices. So we come in and we provide developmental support, education that's appropriate for the patient to understand. The goal is to decrease the fear of what comes with hospitalization and effort to increase the coping, for the patient and the family as well.

Deborah Howell: Understandable. And what are some of the unique services Child Life brings to the NICU?

Anne Elizabeth Hattier: Well, child life in the NICU probably looks very different than it does, and other units in the hospital. Because what a child life specialist role is, is they take the unit that they're on, the diagnosis that is on that unit, and they adjust their clinical practice, based on the needs of that population. So in the NICU, what that looks like, is supporting patients, supporting their families, at bedside through, helping them understand the medical equipment, adults are not always comfortable we know, and they're not always familiar with the medical equipment.

So my education comes in, let's talk about the equipment, and that also includes siblings that come to visit their new baby brothers and sisters. So helping them not be afraid in the environment, feel comfortable asking questions, making sure that they understand what's happening to their baby and providing opportunities to bond with them. Even when they can't, maybe hold them immediately. But what can we do? Because there's always things that we can do to connect families with their new family member.

So it looks like education. It looks like bonding. It looks like developmental support, as patients grow and heal and become stronger. And how do we introduce those things that they might be doing at home to work on all those different, stages of development and all those domains? Because we want to make sure that we're supporting the emotional, growth, the social growth, cognitive, physical, all of those things are so important and so we just have to be so intentional about it because the world doesn't look like it does outside of here.

Deborah Howell: Yeah, Well, it sounds very compassionate and comprehensive. Now Le Bonheur is one of only three NICU with a therapy dog program. How did you bring this idea to fruition for Le Bonheur?

Anne Elizabeth Hattier: Yes, it is, very exciting. I am super proud, of the work that's being done through the Therapy Dog program. I'm super excited that leadership is so Supportive of the therapy dog program. But when I first came, five years ago, we had a therapy dog come and visit with families in the NICU lobby. And that was just an opportunity for parents, family members to step away, take a break, kind of regroup, and not go too far from their baby. And then reset, talk to other families that were experiencing similar things. And I just thought I would love for the therapy dog to be able to go to bedside.

I think there's just so much positive interaction that can come, from the normalizing experience, but also if there's a way to engage families with their baby in a normalizing experience. How much more beneficial, would that be? And so, COVID happened and the therapy dogs just weren't around. And by the time that they came back, we had toddlers on our unit and I was like, this might be great timing to maybe reassess this and see. And so, I took it to leadership. They asked me to write a proposal and met about it, talked about it, and they were on board about letting me trial it. And it has just continued to thrive.

Deborah Howell: Oh, it's such great news. What are the benefits of therapy dogs, and specifically what are the benefits for NICU patients?

Anne Elizabeth Hattier: Well, being in the NICU, like I said, we have toddlers and they have to be at least one year old. So that means they've been here their entire life. And so at one years of age, if they're developmentally appropriate, medically stable, then what that looks like is we take the dog into the patient's room, we create and modify the environment so that it's not intimidating or overwhelming for the patient. We move slow and steady, let them warm up, just to acclimate to a new experience. It's normalizing to us, but to a patient that's been in the hospital, 12, 14, 16, 18 months that have not been exposed to that outside world.

We want to give them time to observe and process and decide whether or not they can trust the situation. So those are things that infants and toddlers are so important, is learning to trust their caregivers and their environment and we're here to help with that emotional support and attachment. So that's a huge benefit. And also bringing outside normal experiences to them because they can't leave. And what if they go home and they have a pet in their house? So we've bridged that gap and exposed them to something beneficial not just for today, but in the long run.

Deborah Howell: Makes perfect sense. you spoke to this a little bit, but what do NICU patients do during a dog therapy session?

Anne Elizabeth Hattier: So what we do is, usually they're sitting on a play mat or they're sitting with their nurse or sitting with me. And what they do is they just, it's called unoccupied play, where infants, toddler just observe their surroundings to process. So we allow them that time and then the dog will lie on the floor, and interesting enough, what we usually do is we take off their socks and let them begin with their feet because that is, they're less resistance to that new stimuli and that new texture. And so that helps them warm up and they wiggle their toes on the fur and then they rub their feet.

And sometimes they push on the dog, which is good resistance and muscle, tone. And and then we just take their hand, and do hand over hand and let them pet the dog or pet the dog. And if they pull back in their resistance, we give them a break and then we reintroduce it. And then what we find is they begin to reach on their own and they realize that it is safe. And that is a positive experience because so much of the input that infants and toddlers get in the medical environment, they're not necessarily painful experiences, but they're not nurturing, loving, positive things.

So we want to implement as much positive beneficial textures and stimulation and normalizing. And so they really get excited. The ones that, I have seen consistently, they know what the dog is now and they automatically reach and they want a pat. And it's just really a fun experience to watch.

Deborah Howell: so beautiful. I'm getting emotional thinking about it. how does dog therapy impact a child's development?

Anne Elizabeth Hattier: Well, what they're learning is they're learning a new experience, they are exposed to a new stimulation where they become, more comfortable with, new experiences. So when they leave here, going outside for the first time, the wind on their face, seeing how they respond to new experiences. Do they need a little process time? Do they automatically warm up? So then we take that knowledge and we can inform and educate parents like, Hey, we've noticed through these experiences that your child might need a little time to pause and take things in, and warm to new things, or, they are so excited about new experiences.

So the exposure to new experiences, but also bonding with their family if family is involved. Having that just normal engagement of just a family, because it distracts the families a little bit from the medical world. So, they can do something normal and fun and have a happy experience and, bond together. So that helps them build security and trust and attachments with not only our medical caregivers, but with their families as well.

Deborah Howell: How incredibly lovely. Final question for you. What are some of the results you've seen from the therapy dogs in the NICU? Any changes in patients or families?

Anne Elizabeth Hattier: Absolutely. One family in particular, really stands out. I felt like the family was a little hesitant, to maneuver their child just because of the medical equipment. And it's not that they didn't want to, but not everybody is comfortable. And so what the therapy dog did for this particular family is they began to trust that they could do things with their child, that they could maneuver the lines and the different cords, and the tubes and get them out of bed and sit them on the floor.

And what that does is that translated and help them grow and just doing it more easily and more comfortably and more quickly and with less support. And now that this particular family is at home and they're thriving and doing amazing things and so very comfortable with their child and their medical equipment. As for patients, as they continue to grow, we've used the therapy dog for them to learn how to stand and use the therapy dog as something to hold onto and they can stand and pat and gain strength in their legs and learn how to stand independently, and mimic what the dog does.

Just yesterday we had, a patient and she noticed that the dog was kind of just standing there and breathing, and his tongue was hanging out of his mouth, and so she just was watching and then she all of a sudden repeated that. And that just says like, cognitively, I'm connecting with what's happening around me and just that brain development and providing, just a such a fun intervention to be able to play and forget that we're in a hospital for just a little bit.

Deborah Howell: Well, Mary Barbara and Annie Elizabeth, thank you all so much for talking to us today about these innovative NICU programs. It was really inform.

This is the Peds Pod by Lab Bonner Children's Hospital. To learn more about Lab Bonner Children's Hospital and its nicu, please visit lab bonner.org. I'm Deborah Howell. Thanks for listening, and have a great day.