Joy V. Browne, Ph.D., PCNS, IMH-E
In July of 2022, the Consensus Panel for Infant and Family-Cen- tered Developmental Care Standards, Competencies, and Best Practices (IFCDC) began to examine how to implement the standards published in 2020 (1) https://nicudesign.nd.edu/nicu-care-standards/. In 2022, Fragile Infant Forums for Implementation of Standards (FIFI-S) was developed to use implementation science related to complex and varied situations in intensive care. The forums are intended to help professionals effectively integrate the IFCDC standards into practice. During this initial year, the FIFI-S faculty developed evidence-based educational forums and disseminated material for implementing systems change. On the cusp of the second year of FIFI-S expansion, the following overview of progress to date and the next steps are described.
Workshops and presentations held by the FIFI-S leadership group:
A major goal of the leaders of the IFCDC Forums is to disseminate information regarding the standards using implementation science. Many activities have been aggressively pursued in the past year.
In July 2022, a two-day intensive forum focused on Feeding, Eating, and Nutrition Delivery (FEND) standards. Participants were given opportunities to apply and practice using implementation science in real-life clinical situations. One of the FEND Forum results was the development and distribution of a “White Paper” that describes and demonstrates how to effect systems change as it relates to feeding fragile infants. https://nicudesign.nd.edu/assets/491808/fifi_s_white_paper_version_5_10_19_22_jbck-jb_final_2022.pdf In January of 2023, an additional Forum provided opportunities for the consensus panel leaders to learn how to support intensive care systems change using implementation science.
In March of 2023, the FIFI-S faculty presented a workshop at the Gravens meeting on the “Environment of Care for High-Risk Newborns and their Families,” allowing participants to discuss typical opportunities and challenges in implementing the standards in clinical practice. Examples from national and international representatives provided insights into the diversity and cultural challenges of implementing IFCDC standards.
Consensus panel members have presented talks, posters, and other communication to a variety of professional organizations and meetings, including the National Association of Neonatal Nurses (NANN), National Association of Neonatal Therapists (NANT), Family Centered Care Task Force (FCC), Council of International Neonatal Nurses (COINN), National Association of Perinatal Social Workers (NAPSW), National Perinatal Association (NPA), SYNOVA Leadership Forum, and Nationwide Children’s Hospital Neonatal/Perinatal Conference.
Professional Publications by FIFI-S leaders:
Neonatology Today (https://www.neonatologytoday.net) supports a monthly column to disseminate information about the IFCDC standards and the use of implementation science. The first of the articles has focused on the major Infant and Family Centered Care model constructs of 1. the M(other) baby relationship as central to all clinical work; 2. Systems Thinking; 3. Environmental Protection; 4. the Infant as Effective Communicator/Interactor; 4. Individualized Care; 5. Neuroprotection of the Developing Brain; and Infant Mental Health.
Figure 1, Model of Infant and Family-Centered Care. Used with permission.
Consensus Panel leaders wrote chapters in key Developmental Care books for NICU professionals. (2-4) The IFCDC standards served as a template for all the book topics and chapters, further demonstrating the utility of implementing the standards into all aspects of clinical care. (5, 6)
Dissemination of all publications, white papers, and chapters is via the Developmental Care website and can be accessed from https://nicudesign.nd.edu/nicu-care-standards/ifcdc-list-of-pre-sentations-and-publications/
Next steps for IFCDC and FIFI-S in the upcoming year:
In addition to ongoing presentations at national and international meetings, monthly publications in Neonatology Today will focus on the specific evidence-based standards that include Touch and handling, Skin to Skin with intimate family members, State protection, Baby stress and pain, Family stress and pain, and Diversity issues. Other journal articles will continue to be published, notably articles on the synergistic effects of integrating NICU design and IFCDC standards and how to utilize metrics to evaluate change.
The Gravens meeting in 2024 in Clearwater Beach, Florida, will allow attendees to focus on the science and implementation of three of the major standard domains and will provide opportunities to discuss challenges and successes they have encountered in their clinical implementation experience. The following year, an additional three major standard domains will be presented along with revisions to the current IFCDC standards.
In the upcoming year, there will be an emphasis on updating the standards to include recent evidence and make the standards more usable and accessible to intensive care professionals. Recommendations for changes have been invited so that representation from those in the field with concerns regarding gaps, publications, necessary adjustments, etc., can be addressed. Forms for making recommendations are found on the following web page: ifcdc_standards_proposal_form_for_revisions_2022_2023. The consensus panel will be taking strides to integrate Diversity, Equity, and Inclusion, Continual Contact between Baby and Mother, Discharge Planning, Infant Mental Health and Advocacy into every standard and/or competency.
Conclusion:
The initial year of FIFI-S has provided a sound foundation for implementing the IFCDC Standards, competencies, and best practices in intensive care. FIFI-S activities included educational forums, seminal papers on implementation science and published articles on clinical practice systems change. The foundation developed during the first year by committed FIFI-S leaders will provide a springboard for disseminating and integrating the standards to optimize baby and family outcomes.
References:
- Browne JV, Jaeger CB, Kenner C. Executive summary: standards, competencies, and recommended best practices for infant- and family-centered developmental care in the intensive care unit. Journal of Perinatology: official journal of the California Perinatal Association. 2020;40(Suppl 1):5-10.
- Jaeger CB, Browne JV. The Science. In: Kenner C, McGrath JM, editors. Developmental Care of Newborns and Infants: A Guide for Health Professionals. Third ed: Wolters Kluwer; 2023. p. 1-17.
- Jaeger CB, Browne JV. The infant and family-centered de- velopmental care standards for babies in intensive care and their families. In: Kenner C, McGrath JM, editors. Developmental Care of Newborns and Infants: A Guide for Health Professionals. Philadelphia: Wolters Kluwer; 2023. p. 18-34.
- TALMI A, BROWNE J, editors. REGULATION, RELATIONSHIPS. Behavioral Health Services with High-Risk Infants and Families: Meeting the Needs of Patients, Families, and Providers in Fetal, Neonatal Intensive Care Unit, and Neonatal Follow-Up Settings; 2022: Oxford University Press.
- Kenner C, McGrath JM. Developmental care of newborns & infants: Lippincott Williams & Wilkins; 2021.
- Dempsey AG, Cole JC, Saxton SN. Behavioral health services with high-risk infants and families: meeting the needs of patients, families, and providers in fetal, neonatal intensive care unit, and neonatal follow-up settings: Oxford University Press; 2022.
Acknowledgment: We thank Dr. Carol Jaeger for her unparal- leled administrative guidance, goal-setting, and encouragement to stay on task. We also thank Dr. Mitchell. Goldstein for his unwavering and enthusiastic support for the FIFI-S efforts and Dr. Bill Sappenfield for assuring the ongoing success of FIFI-S.
Disclosures: There are no conflicts of interest or sources of funding to declare.