618 - Standard versus Enhanced Social Needs Screening and Referral to Resources in the NICU: a Mixed-Methods Study

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 618
Publication Number: 618.14

Erika G.. Cordova-Ramos, Boston Medical Center, Wellesley, MA, United States; Maria Estevez, Boston Medical Center, Boston, MA, United States; Maggie McGean, Boston University School of Medicine, Boston, MA, United States; Nicole Sileo, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Megan Sandel, Boston University School of Medicine, Boston, MA, United States; Margaret Parker, UMass Memorial Medical Center, Worcester, MA, United States

Presenting Author(s)

Erika G. Cordova Ramos, MD (she/her/hers)

Assistant Professor of Pediatrics
Boston University School of Medicine
Wellesley, Massachusetts, United States

Background: While addressing health-related social needs is becoming a norm in outpatient pediatric clinics, less is known about what interventions should look like in the NICU. Social needs impact breastfeeding continuation in the NICU but interventions targeting social needs to promote breastfeeding are lacking.

Objective: To compare a standard (screening and referral) versus enhanced (standard plus peer navigation) intervention aimed at addressing social needs in the NICU. Our secondary aim was to compare breastfeeding outcomes between interventions.

Design/Methods: We conducted a pre-post mixed-methods evaluation of two interventions implemented sequentially in a level III NICU in Massachusetts: Standard: (Nov2020-Jan2022) social needs screening and provision of written resources by existing NICU staff; Enhanced: (March-Dec2022, ongoing) standard intervention plus longitudinal in-person assistance by a breastfeeding peer counselor trained in navigation of social services. The navigator was a trilingual and bicultural Black mother. We used statistical process control charts to track quantitative data including rates of: (1) eligible families screened; (2) unmet needs addressed, and (3) any mother’s milk provision at NICU discharge; and chi-square tests to compare rates between periods. We used thematic analysis of semi-structured interviews with 42 caregivers to contextualize quantitative findings.

Results: 212 and 175 families were included in periods 1 and 2, respectively (Table 1). Rates of screening increased from 49% to 86% (p< 0.001). Among families screened who desired assistance, rates of unmet needs addressed increased from 52% to 70% (p< 0.001). Rates of any mother’s milk at discharge increased from 54% to 69% (p=0.01). Across both intervention periods, caregivers expressed acceptability of social needs screening during the NICU hospitalization; and shared their insights about the links between addressing unmet needs with better family engagement and preterm infant health. During the enhanced intervention, caregivers emphasized the importance of shared power and respect when screening for social needs, and of peer support, racial and language concordance to establish trust; and described deep appreciation for longitudinal hands-on assistance to connect with resources.

Conclusion(s): Trained lay peers can effectively integrate social needs screening and linkage to resources within NICU healthcare delivery while supporting key health-promotion activities such as breastfeeding. Understanding families’ perspectives of social care interventions in the NICU should help drive implementation.