752 - Creation and Implementation of a Novel Cognitive Behavioral Therapy to Improve Parent Perceptions of Child Vulnerability in the NICU

Publication Number: 1728.752

Margaret K. Hoge, UT Southwestern, Dallas, TX, United States

Background: Neonatal Intensive Care Unit (NICU) maternal emotional trauma heightens parental perceptions of child vulnerability (PPCV) and can result in adverse child developmental outcomes, known as Vulnerable Child Syndrome (VCS). Treatment standards do not exist to address this important trauma-based entity with long-term post-NICU impacts. A standardized approach to treating PPCV in parents of premature NICU infants in crucial for parents and continued assessment of novel ways to improve child outcomes.

Objective: The objective was to successfully develop and implement a standardized CBT intervention for NICU parents of preterm infants to help improve their PPCV.

Design/Methods: A CBT manual of 5 sessions was adapted from the framework of a CBT manual originally made to address parent anxiety and depression in the first 4-5 weeks of a NICU admission. The 5 novel CBT sessions spanning NICU discharge (3 in NICU, 2 post discharge) focus on teaching concepts of stress recognition and physical stress mitigation exercises. Building upon these skills, concepts of NICU psychological trauma are introduced. NICU traumatic events are explained in the conceptual teaching of VCS's trauma origins and how to integrate cognitive thought restructuring into daily practice for worrisome scenarios for NICU graduates. Clinicians from the NICU and NICU follow up clinic qualitatively assessed what topics were most worrisome to parents of their pediatric patients. This input was used to create NICU related scenarios that would be worrisome for parents to teach concepts of cognitive though restructuring. CBT Providers were trained in a role-play scenario. Sessions were recorded and fidelity ratings were measured. Parents of premature NICU infants born at Dallas' County Hospital, Parkland Hospital, were enrolled.

Results: The CBT manual was successfully developed and implemented with 8 separate trained CBT providers, with high fidelity. PPCV reduced in parents undergoing the treatment. Parent satisfaction was high, with all agreeing or strongly agreeing that the CBT material was helpful and that other NICU parents should learn the content.

Conclusion(s): The clinician adapted CBT manual improved PPCV and is feasible to train providers to implement it spanning NICU discharge in an underserved population. Future efforts will focus on understanding factors to participate or decline CBT intervention for the population to improve access to effective care.

Figure 1. Cognitive Behavioral Therapy Intervention Contents
PMA= Post menstrual age

Results of Cognitive Behavioral Therapy