Empower NICU - A Bridge to Resources for Adjusting and Coping with Emotions (EmBRACE)

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Project Summary Abstract The extreme emotional strain of parenting an infant in the fast-paced medicalized Neonatal Intensive Care Unit (NICU) setting can be detrimental to mental health and functioning with up to 70% of parents experiencing clinically significant levels of depression, anxiety and trauma symptoms. Poor parental mental health contributes to maladaptive coping and can impair parental functioning, parent-infant attachment, and long-term infant development. Therefore, early identification of and support for parents at-risk for clinical distress is of paramount importance. Clinical and research experts have recommended universal screening and ongoing mental health assessment for all NICU parents to identify specific needs and offer appropriate levels of support. Unfortunately, widespread implementation of a clinically practical approach has not been achieved. Barriers to screening include competing demands on parents’ time and focus during daytime hours, such as participating in infant care, pumping/breastfeeding, meeting with health care providers (HCPs), and making complex decisions about life-threatening medical procedures, as well as job demands and caretaking for their other children. Obstacles such as staff availability (e.g., to screen and treat during evenings and weekends) and staff burden limit service implementation to parents given the focus on medically complex infants receiving intensive care. Mobile health (mHealth) interventions offer an innovative approach to tackle these barriers. The overarching goal of the current proposal is to develop and test a novel mHealth app entitled, EmBRACE (Empower NICU – A Bridge to Resources for Adjusting and Coping with Emotions) to establish: 1. Universal mental health screening while giving NICU parents control over when and where assessments are completed; 2. Ongoing mental health monitoring using a set of quick daily assessments (via ecological momentary assessment) and weekly screenings; 3. Provision of customized microlearning education (e.g., 1-3 minute videos) tailored to assessment results and referrals in a stepped-care approach; and 4. Use of a sustainable contingency management approach to increase parent compliance with assessments, microlearning, and referral follow-up. In the R21 phase, we aim to 1) conduct formative research with NICU parents and HCPs that leverages a user-centered design and the PRECEDE-PROCEED theoretical model to develop the EmBRACE prototype; and 2) evaluate the feasibility (usability, acceptability, and clinical applicability) of EmBRACE with 20 current NICU parents. In the R33 phase, we aim to 1) revise the EmBRACE platform; and 2) conduct a multisite, pilot randomized controlled trial in NICUs located across the U.S. with 120 current NICU parents to test EmBRACE’s efficacy relative to an active comparator group. EmBRACE has the potential to reduce the significant gaps in mental health care for NICU parents by providing universal screening, ongoing monitoring, and linkage to tailored psychoeducation and referrals, thereby assisting overburdened NICU HCPs, and ultimately promoting best practices to optimize parent and infant outcomes.