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The added value of a family-centered approach to optimize infants' social-emotional development: A quasi-experimental study.

ABSTRACT: Family-centered care (FCC) has been related to positive healthcare outcomes in pediatric care. Our aim was to assess whether an FCC approach also leads to better and earlier identification of social-emotional problems and less child psychosocial problems at age 18 months.In a quasi-experimental study within routine well-child care in the Netherlands, we compared those regions in which an FCC approach was implemented (FCC-JointStart) to those regions with "care-as-usual" (CAU), including all children. In all regions, professionals performed well-child visits (2-18 months) and assessed social-emotional problems, or risks developing these, by rating outcomes of assessments as "not optimal" or as "a problem." We compared FCC-JointStart and CAU regarding the rates of newly identified (risks for) social-emotional problems, the pace of identification over time, and the child's psychosocial wellbeing at eighteen months as measured by the Child Behavior Checklist (CBCL). For participants that received extra care, we compared FCC-JointStart and CAU regarding the severity of parent-reported problems. Parents were blinded, professionals were not.5658 parents (68%) agreed to participate in the study. In the FCC-JointStart group, risks were identified more frequently, though differences were small (24.7% versus 22.0%, odds ratio (95%-confidence interval) adjusted for confounders: 1.44 (0.96; 2.18), Phi = .03). Risks were also identified earlier (p = .008), and additional care was provided to more severe cases than in CAU. Effect sizes r ranged from 0.17 (PSBC) to 0.22 (FAD). CBCL scores at 18 months did not differ between groups.FFC-JointStart may contribute to more and earlier identification of risks for social-emotional problems and of families that need additional care, but not to fewer child psychosocial problems at age 18 months.Netherlands Trial Register NTR2681.

SUBMITTER: Reijneveld SA

PROVIDER: S-EPMC5739404 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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The added value of a family-centered approach to optimize infants' social-emotional development: A quasi-experimental study.

Reijneveld Sijmen A SA Hielkema Margriet M Stewart Roy E RE de Winter Andrea F AF

PloS one 20171221 12

<h4>Objective</h4>Family-centered care (FCC) has been related to positive healthcare outcomes in pediatric care. Our aim was to assess whether an FCC approach also leads to better and earlier identification of social-emotional problems and less child psychosocial problems at age 18 months.<h4>Methods</h4>In a quasi-experimental study within routine well-child care in the Netherlands, we compared those regions in which an FCC approach was implemented (FCC-JointStart) to those regions with "care-a ...[more]

PMID: 29267270

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Project description: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.

Project description:BackgroundFamily Centered Care (FCC) has been widely adopted as the framework for caring for infants in the Neonatal Intensive Care Unit (NICU) but it is not uniformly defined or practiced, making it difficult to determine impact. Previous studies have shown that implementing the Family Integrated Care (FICare) intervention program for preterm infants in the NICU setting leads to significant improvements in infant and family outcomes. Further research is warranted to determine feasibility, acceptability and differential impact of FICare in the US context. The addition of a mobile application (app) may be effective in providing supplemental support for parent participation in the FICare program and provide detailed data on program component uptake and outcomes.MethodsThis exploratory multi-site quasi-experimental study will compare usual FCC with mobile enhanced FICare (mFICare) on growth and clinical outcomes of preterm infants born at or before 33 weeks gestational age, as well as the stress, competence and self-efficacy of their parents. The feasibility and acceptability of using mobile technology to gather data about parent involvement in the care of preterm infants receiving FCC or mFICare as well as of the mFICare intervention will be evaluated (Aim 1). The effect sizes for infant growth (primary outcome) and for secondary infant and parent outcomes at NICU discharge and three months after discharge will be estimated (Aim 2).DiscussionThis study will provide new data about the implementation of FICare in the US context within various hospital settings and identify important barriers, facilitators and key processes that may contribute to the effectiveness of FICare. It will also offer insights to clinicians on the feasibility of a new mobile application to support parent-focused research and promote integration of parents into the NICU care team in US hospital settings.Trial registrationClinicalTrials.gov, ID NCT03418870. Retrospectively registered on December 18, 2017.

Dataset Information

The added value of a family-centered approach to optimize infants' social-emotional development: A quasi-experimental study.

Publications

The added value of a family-centered approach to optimize infants' social-emotional development: A quasi-experimental study.

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