EmBRACE: Empower NICU – A Bridge to Resources for Adjusting and Coping with Emotions

Annually, 15% of U.S. births result in a Neonatal Intensive Care Unit (NICU) hospitalization.  The extreme emotional strain of parenting an infant in the fast-paced medicalized NICU settings can be detrimental to mental health and functioning, with up to 70% of NICU parents experiencing depression and severe anxiety. Moreover, parents experience chronic stress and trauma from the day-to-day threats in the NICU, putting them at risk for posttraumatic stress disorder. Addressing parental mental health and sequelae is critical given the potentially devastating consequences for parents and children, such as significantly impaired parent-infant interactions and attachment, infant development, and parent-provider interactions. Despite the clear need, many NICUs do not address parent mental health needs as a universal standard of care. Approximately 70% of NICU parents are not routinely screened or identified for mental health symptoms and thus do not receive the mental health services they need, creating notable health disparities. Experts and emerging research recommend a Standards of Care embedded in the NICU that includes universal screening, ongoing mental health monitoring, psychoeducation, and a stepped-care approach to best serve NICU parents that optimizes and tailors services based on the unique needs of the parent. Unfortunately, widespread implementation of a clinically practical system based on expert recommendations has not been achieved. We propose to develop a mHealth app entitled Empower NICU – A Bridge to Resources for Adjusting and Coping with Emotions (EmBRACE) to provide: 1. Universal mental health screening while giving NICU parents control over when and where assessments are completed; 2. Ongoing mental health monitoring using a set of quick, daily assessments (via ecological momentary assessment) and weekly screenings; 3. Customized microlearning education (e.g., 1-3 minute videos) tailored to assessment results and referrals in a stepped-care approach; and 4. A sustainable contingency management approach to increase parent compliance with assessments, microlearning, and referral follow-up.