Calling Social Workers: Integrating Trauma-Informed Perinatal Mental Health Care in the NICU

Background and Purpose: Approximately 10% of babies born in the United States require neonatal intensive care unit (NICU) hospitalization, an often-unanticipated event that is highly stressful and traumatic for their families. Parents of NICU hospitalized infants have increased risk of depression, anxiety, NICU-related post-traumatic stress disorder, and substance use. Trauma and adverse parental behavioral health threaten to compromise parent-child bonding and parenting practices, ultimately impacting child health and development. Despite the prevalence of adverse parental behavioral health and trauma and its impact on parent and child well-being, many NICUs do not have structural mechanisms to provide trauma-informed behavioral health support for NICU parents. While behavioral health providers such as social workers exist within NICUs, their roles typically involve crisis intervention, case management, and connecting families to community resources upon discharge from the NICU. Research suggests the importance of supporting parent behavioral health in NICUs, but more research is needed to identify potential interventions and their acceptability to both NICU parents and stakeholders. This study’s objectives were to 1) identify the behavioral health needs of NICU parents from the perspectives of NICU parents and NICU stakeholders, and 2) identify barriers and solutions to meeting those needs from the perspectives of NICU parents and NICU stakeholders.

Methods: This qualitative study included semi-structured interviews with NICU parents and NICU stakeholders from a hospital in the Pacific Northwest. We used purposive sampling to recruit participants, and conducted interviews to explore participants’ impressions of: a) the most pressing parent behavioral health needs in the NICU, b) barriers to accessing behavioral health support, and c) the acceptability of an integrated parent behavioral health support program. We transcribed interviews and conducted a thematic analysis, using an inductive approach, at a semantic level. To enhance rigor and quality, study methods included triangulation through NICU observation, field notes, and peer debriefing.

Results: Participants included a diverse set of NICU parents including current and former NICU parents, mothers, fathers, English-speaking parents, Spanish-speaking parents, parents living in rural and surrounding metropolitan areas, and parents of infants with a range of medical issues requiring NICU hospitalization. Participants also included various NICU stakeholders including nurses, nurse practitioners, case managers, hospitalists, social workers, physicians, and front desk staff. Our analysis led to the following themes: 1) emotional needs change with time, 2) parents as knowers, 3) consistency reduces anxiety, and 4) NICU primed for change.

Conclusions and Implications: Contemporary trends in NICU care emphasize the importance of family engagement, and health care systems are increasingly aware of the value of attending to the behavioral health of parents of hospitalized children. Our findings resonate with trauma literature and lead us to consider how trauma-informed care (TIC) might guide NICU parent behavioral support efforts. In particular, TIC principles of safety, trustworthiness and transparency, collaboration and mutuality, and empowerment and choice may inform practice and policy responses to NICU parent experiences. Findings also contribute to trauma and TIC literature as scholars consider how the experiences of parents with NICU-hospitalized infants deepen our understandings of trauma and resilience.