Small Things First: Leveraging Implementation Science to Increase Access to Infant Directed Speech for ALL Infants in Neonatal Intensive Care Units

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Project Summary/Abstract Adequate language input is required for typical language development. However, NICU infants are at particularly high risk for experiencing a language deprived environment and may spend weeks-to-many-months of a critical developmental period in this setting. Importantly, we know that the language environment of the NICU matters: the quantity and quality of language input an infant receives in the NICU has been associated with positive short-and-long-term outcomes (e.g., attentiveness, alertness, vocalizations, conversational turns, language, development). Infant directed speech (IDS), is a highly promising language construct, that is defined as a pattern of speaking adults use with infants and young children that has a simpler phonology, grammatical structure, and fewer lexical items as well as a higher pitch and unusual intonation pattern. Increased use of IDS has been found to be predictive of better language outcomes in typically developing infants. Increasing the quantity of IDS in the NICU may be a simple, low-training, high-impact intervention that could bolster early language outcomes for NICU infants (e.g., verbalizations, conversational turns). For NICU infants, it is imperative that we task both parents and clinicians as co-primary providers of routine IDS due to significant existing barriers to parent visitation. However, tasking clinicians to use IDS during routine care will likely face organizational, innovation, and clinician-level barriers that may impact clinician intentions. To successfully increase all infants’ access to IDS, it is necessary to conduct preliminary implementation research prior to a Hybrid Type 1 (effectiveness- implementation) study to identify and understand: 1) barriers to parent visitation and intentions to use IDS with their hospitalized infant (with semi-structured interviews, surveys); and 2) identify and understand barriers and facilitators to NICU clinician use of IDS (with surveys, video-elicitation interviews; video simulation surveys). To conceptualize this work, we are modifying the Explore Plan Implement Sustain implementation framework to incorporate health equity factors as part of the outer context and use organizational and psychological theories of behavior to explore and refine a possible causal model of contributors to parent and clinician intentions to use IDS with NICU infants. Completing the proposed research will allow us to refine our causal model by identifying an exhaustive list of societal, organizational, innovation, and individual factors (i.e., barriers, facilitators) that may impact or moderate parent intentions to visit and parent and clinician intentions to use IDS in the NICU. Finally, the training and research activities proposed in the K23 application will support the PI in having the data, skills, and experiences necessary to submit a strong application for a multi-site Hybrid Type I (effectiveness- implementation) trial that examines 1) whether we can significantly increase adult use of IDS in the NICU (i.e., parent/visits, clinician/routine care); and 2) whether infants who received higher levels of IDS demonstrated more verbalizations, vocalizations, and conversational turns at discharge (adjusting for gestational age).