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

项目摘要 在快节奏的医疗化新生儿重症监护病房养育婴儿的极端情绪紧张 （NICU）环境可能对心理健康和功能有害，高达70%的父母经历 抑郁焦虑和创伤症状的临床显著水平。父母心理健康状况不佳 适应不良的应对，并可能损害父母的功能，亲子依恋，和长期的婴儿 发展因此，尽早识别和支持父母在临床痛苦的风险是至关重要的 重要性临床和研究专家建议普遍筛查和持续的心理健康 评估所有新生儿重症监护室的父母，以确定具体的需求，并提供适当的支持水平。不幸的是， 尚未实现临床实用方法的广泛实施。筛查障碍 包括在白天时间对父母时间和注意力的竞争性要求，例如参与婴儿 护理、泵送/母乳喂养、与医疗保健提供者（HCP）会面，并就以下问题做出复杂的决定 危及生命的医疗程序，以及工作要求和照顾其他孩子。障碍 例如工作人员可用性（例如，在晚上和周末进行筛查和治疗）和工作人员负担限制服务 鉴于重点是接受重症监护的病情复杂的婴儿，移动的健康 移动健康干预措施为解决这些障碍提供了一种创新方法。当前的首要目标是 一项提案是开发和测试一款名为EmbRACE（Empower NICU - A Bridge to 调整和应对情绪的资源）建立：1。普及精神健康筛查， 让新生儿重症监护室的父母控制何时何地完成评估; 2.持续的心理健康 使用一套快速的每日评估（通过生态瞬时评估）和每周一次的监测 筛选; 3.提供定制的微型学习教育（例如，1-3分钟的视频） 结果和转介在一个阶梯式护理方法;和4.使用可持续的应急管理 提高家长对评估、微型学习和转诊后续行动的依从性的方法。在R21 阶段，我们的目标是1）与NICU父母和HCP进行形成性研究，利用以用户为中心的 设计和PRECEDE-PROCEED理论模型，以开发EmbRACE原型;以及2）评估 EmBRACE在20名当前NICU父母中的可行性（可用性、可接受性和临床适用性）。在 在R33阶段，我们的目标是：1）修订EmBRACE平台; 2）进行多中心、试点随机化 在美国各地的NICU中进行了一项对照试验，其中有120名目前的NICU父母，以测试EmBRACE的疗效 相对于活性对照组。拥抱有可能减少心理上的重大差距， 通过提供普遍筛查，持续监测和与定制的 心理教育和转诊，从而帮助负担过重的NICU HCP，并最终促进最好的 实践，以优化父母和婴儿的结果。

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.