Hospitals in pursuit of excellence

Integrating Behavioral Health into the NICU

With four hospitals and more than 120 employed medical providers, St. Charles Health System is a provider of medical care in Central Oregon.

Interventions
There are three primary interventions are used by St. Charles in the NICU psychology program; assessment, brief therapeutic intervention and education. The assessment portion of the work involves formally and informally investigating for the possibility of post-partum depression through empirically validated measures and semi-structured clinical interviews. Assessment also involves looking for research driven social and emotional factors that can increase the likelihood of mood disorder, or can serve as protective factors. Therapeutic intervention can often be supportive in nature; but is more likely to be skills based (i.e. coping skills, relaxation, behavioral activation for mood). Intervention often also involves coordinating long-term care with community resources for some families with more significant needs. Education is also a crucial role as a NICU psychologist. Families are provided with information regarding attachment, bonding and developmental concerns.

Results
St. Charles has seen some growth to the role of the psychologist in the NICU and positive parental feedback. For example, at the request of the hospital, psychologists are used in development of an infant loss program and in a protocol to provide services to mothers on bed rest and in preterm labor. In addition, group curriculum has been developed in order to present the most important education information to as many of the NICU families as possible. Parental feedback regarding psychologist’s role on the NICU has been overwhelmingly positive. Parents are using the service appropriately; asking for help when extra support is needed and reporting back to the psychologists regarding their experience with certain recommended coping/distress management skills. Parents have also noted an appreciation for the continuity of care, since the NICU psychologists are part of the NICU follow up clinic.

Lessons Learned:

• Assessing paternal risk factors and providing subsequent appropriate interventions with limited information.
• Providing additional support to staff is integral part of a role of the NICU. 
• The biggest challenge to date has been finding a way to meet with all the NICU patients. Due to NICU visitation schedules, it is often challenging to find time to meet with all of NICU families.

Contact:

Laurie Shank , St. Charles Health System
2500 NE Neff Road
Bend, OR 97701