220 - Telehealth Delivered Novel Cognitive Behavioral Therapy Intervention in an Underserved NICU Parent Population - Feasibility and Parental Satisfaction

Publication Number: 3212.220

Margaret K. Hoge, UT Southwestern, Dallas, TX, United States; Maria Caraig, UT, Grand Prairie, 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 for this important entity. A recent novel in-person CBT (pCBT) treatment course of 5 sessions spanning NICU discharge improved PPCV; there was attrition due to transportation challenges in the underserved population which limited intervention completion despite parent satisfaction and endorsing material was helpful. Telehealth CBT (tCBT) could be a potential solution for therapy access given its non-inferiority to in-person CBT (pCBT) in previous studies. There is a need to better understand if a tCBT intervention surrounding NICU discharge is feasible and satisfactory to help expand access to a novel CBT intervention addressing VCS.

Objective: We hypothesize that utilizing tCBT for delivering CBT intervention addressing PPCV and VCS surrounding NICU discharge will be feasible and satisfactory to an underserved NICU parent population.

Design/Methods: This feasibility and satisfaction study is part of a randomized controlled trial comparing tCBT sessions to standard of care for NICU families. Families were enrolled in tCBT May 2024 through Oct 30, 2025. Eligibility criteria: English and Spanish speaking, parents of preterm infants ( < 31 weeks gestational age). Exclusion: congenital anomalies or child protective services involvement. Enrollment occurred at Dallas' county hospital, Parkland Hospital. CBT intervention protocol is 3 weekly CBT sessions starting at 34 weeks post menstrual age and 2 monthly CBT sessions starting one month post NICU discharge. tCBT session completion rates and parent-reported session satisfaction ratings were tracked for each protocol eligible CBT session and compared to previously published pCBT epoch rates.

Results: tCBT epoch included 27 mothers, of which 100% have public insurance. tCBT completion rates per session was 83% or higher which was improved overall from lowest pCBT completion rate of 72%. Average mother tCBT satisfaction ratings were 4.52 out of 5, stating information learned was helpful and other parents should learn content. 2 tCBT sessions (4%) were able to be completed by telehealth where previous pCBT would not have been feasible due to transpiration limitations (3 families were withdrawn from pCBT due to transportation problems).

Conclusion(s): Delivery of tCBT is feasible with sustained completion rates and satisfactory in an underserved NICU patient population, which could help improve access to effective care.

Figure 1. Study enrollment and completion rates flow diagram.
NICU = Neonatal Intensive Care Unit; OSH= outside hospital; GA= gestational age; CPS= Child protective services; CBT= Cognitive Behavioral Therapy


Table 1: Baseline maternal and infant demographics for enrolled CBT intervention patients in both in-person or telehealth delivered CBT.
CBT= Cognitive Behavioral Therapy; pCBT= In-Person Cognitive Behavioral Therapy; tCBT= Telehealth Cognitive Behavioral Therapy, IQR= Interquartile Range

Table 2. Telehealth versus In-Person CBT Completion Rates and Parent Satisfaction Averages
pCBT= In-Person Cognitive Behavioral Therapy; tCBT= Telehealth Cognitive Behavioral Therapy