Sangeeta Balachandran Mallik, PhD, Dongli Song, MD, PhD, Sudha Rani Narasimhan, MD, Laura Berritto, Rupalee Patel, DNP, MS, BSN, C-PNP, C-PHN, IBCLC Priya Jegatheesan, MD 

Introduction: 

Family-centered care (FCC) is a critical part of NICU care. Families feel intense stress and anxiety during their infant’s stay in the NICU (1–3). Many parents are ill-equipped to handle the adverse experience, which can lead to long-lasting negative impacts on parental well-being and their children’s health and development. A family’s need to be heard, understood, respected, and supported by NICU staff is the key to establishing a strong partnership between families and the NICU team. Family participation in routine infant care, positive parent-infant interaction, and shared decision-making with NICU staff are shown to decrease parental anxiety and stress levels, as well as later posttraumatic stress disorder (PTSD) (4–6). A supportive and nurturing environment improves the family’s overall experience during NICU stay and the family’s long-term outcomes, given the manifold early bonding and caring opportunities for families in the NICU with their infants (4, 7–9). 

While increasing evidence has shown the benefits of family-centered and family-integrated care in NICU, establishing and incorporating a sustainable FCC program in routine clinical practice faces many challenges (10). In this paper, we describe how our NICU FCC program, in a safety net hospital, uniquely supports NICU families and how the FCC team, over the years, has become an integral part of the clinical care team, NICU care, and decision-making. 

Context: NICU in a Safety Net Hospital Setting: 

Santa Clara Valley Medical Center (SCVMC) NICU is an AAP level IV, California regional 40-bed NICU with 300–350 annual NICU admissions housed in a safety net hospital in San Jose, California. Safety net hospitals are committed to providing care for people with limited or no access to healthcare due to socioeconomic circumstances, insurance status, or health conditions. The mission of the Santa Clara County healthcare system is to provide high-quality, accessible healthcare and service to all persons in the county regardless of their socioeconomic status and ability to pay. This healthcare system comprises 3 Hospitals with associated Clinics and supports 20–25% of county births, with approximately 4,500 deliveries annually. 

SCVMC FCC Program Development and Growth: 

The FCC program journey at SCVMC NICU started in partnership with the March of Dimes program in 2009 when our site became one of their first ten NICU family support sites through a competitive grant application process. The program introduced FCC care into our NICU by providing patient education with a kiosk and staff education. Over the 15 years, the program’s focus has been to promote a culture change incorporating FCC in every aspect of NICU care. Since 2012, the FCC program has been supported with extramural funding essential for continuous progress in the FCC and building a team of paid FCC team members in a safety net hospital. 

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Conclusion: 

FCC is necessary for improving the quality of care and outcomes of high-risk infants and their families’ well-being. Our 15-year journey has built a strong, effective, and sustainable FCC program that has transformed the culture of our unit and helped thousands of NICU families. A NICU mother best summarizes the impact of our FCC program: “The memories of this place and what all the NICU staff did for me truly hit six months after discharge when your baby is hitting their milestones, and they are starting to become healthy. You look back and realize how much hope the NICU gave you. The stories that I heard from my Family Support Specialist and other mothers, and the encouragement that I received from the NICU staff was so profound when I got to the other side—I realized how much they carried me through that time when I was in the NICU.” 

References: 

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2. Lefkowitz D, Baxt C, Evans J. Prevalence and correlates of posttraumatic stress and postpartum depression in parents of infants in the neonatal intensive care unit (NICU). J Clin Psychol Med Settings. 2010; 17:230–7. https://doi.org/10.1007/s10880-010-9202-7. 
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