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- Baraldi, Erika, 1982-
(författare)
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An Interaction-Based Early Intervention During the First Year of Life : Targeting Infants Born Extremely Preterm and Their Parents
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The first thousand days from conception are crucial for future learning and development throughout life. During the infant year, several sensitive periods for sensorimotor, cognitive and social development coincide, making the period particularly suitable for early intervention (EI). From a special educational perspective, the social and physical environment of a child may either support or hinder future growth. Optimal early learning environments include environmental enrichment, reduced toxic stress and strengths-based support of parent-child interaction.Being born extremely preterm (EPT <28 gestational weeks) is a biological risk factor, increasing the risk for future disability, academic difficulties and social challenges. The parents are also negatively affected by prematurity. Sweden offers highly specialized neonatal care from 22 GW, resulting in a new population of surviving children.The aim of this thesis is to evaluate an interaction-based and strengths-based EI for infants born EPT and their parents in a Swedish context. The Stockholm Preterm Interaction-Based Intervention (SPIBI) consists of 10 home visits led by a trained interventionist during the first year at home, focusing on parent-child interaction, family strengths and reduction of toxic stress. The control group received an extended treatment as usual follow-up program (TAU+). The thesis has a mixed methods design and includes three studies.Study I presents the protocol, including a description of the planning, formulation, theoretical background, theory of change, interventionist training, recruitment, randomization and implementation of the SPIBI. Study II reports the primary outcome of the RCT (N=130, intervention=66 vs. controls=64) and their parents regarding parent-child interaction as measured with the Emotional Availability Scale (EAS) at 12 months corrected age (CA). The EAS consists of the six dimensions: sensitivity, structuring, non-intrusiveness, non-hostility, child responsiveness and child involvement. No significant effect of the EAS at 12 months CA related to the SPIBI was found. In the secondary analysis, analysis of covariances for all EAS dimensions were tested with predefined medical, social, and psychological moderators. The model with the best fit was one for the EAS dimension child involvement (adj R2=.463). A significant effect modifier shows that the SPIBI enhances child involvement in families where the mothers rate themselves as depressed at discharge (F(1, 65)=5.499, p=.023).The parental experience during the first year at home with or without the SPIBI was qualitatively analyzed and reported in Study III (n=17). The results showed that child-related medical concerns were still present a year post-discharge, and that the premature birth experience still affected the parental inner state and family dynamics. Parents in the intervention group (n=8) also pointed out the security the knowledgeable interventionists gave them, while some parents described the SPIBI as important but not necessary.Overall, this thesis adds to the understanding of the first year at home with a child born EPT. An interaction-based intervention in the home environment is feasible in Sweden. It is possible to unite different professions in an EI in a special educational context. The tested intervention does not affect the emotional availability at 1 year CA, but findings from secondary analyses prompt further research on specific subgroups, particularly families with depressed mothers.
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- Baraldi, Erika, 1982-, et al.
(författare)
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Clinical Protocol & Research Process of Stockholm Preterm Interaction-Based Intervention, SPIBI
- 2019
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Ingår i: Pediatric Research. - : Springer Science and Business Media LLC. - 0031-3998 .- 1530-0447. ; 86:Suppl., s. 54-55
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundExtremely preterm (EPT) born children are at increased risk of cognitive and neurodevelopmental impairment, neuropsychiatric disorders and academic difficulties. Parents of EPT born children are extra vulnerable for anxiety, posttraumatic stress disorder and depression and the parent-child interaction is negatively affected by prematurity. There is some evidence that early interventions have beneficial effects on neurocognitive and motor outcomes (Spittle A et al 2015). Based on a previous intervention (Verkerk G et al 2012) and adjusted to the Swedish context with 480 days paid parental leave, we created a post–discharge intervention, SPIBI, for families of EPT born children.MethodThe aim of (SPIBI) is to improve the quality of the parent-child interaction, child development and parental mental health in families with EPT born children. . SPIBI is a randomized controlled beginning at discharge and lasting until the child is 12 months corrected age. The trial design is a two arm randomized trial with four recruiting sites in Stockholm. Intervention group (target, n=65) receives 10 visits and two telephone calls from a trained interventionist and the control group (target n=65) receives treatment as usual plus an extended follow-up program. The SPIBI-team has recruited and trained 6 multi-professional and NICU-experienced interventionists. The training takes one year (0.2 of full time) and the content was both theoretical and practical, including pilot-cases. ResultSPIBI is an ongoing research project, beginning the 1st of September 2018 and planning to end recruitment the 31st of August 2020 and finishing the home-visits in August 2021. By the end of April 2019, 33 eligible infants had been identified within the four neonatal units in Stockholm; of which 26 children approved and 7 children declined participation. At this stage, three children have dropped out of the study, because of severe social challenges and child death. Identified challenges have been social and medical vulnerability of the EPT-families, finding the optimal multi-professional balance of motoric, psychological, pedagogical and medical kernels of the intervention, ethical considerations when to ask families for participation, lack of long-term discharge-planning of the neonatal units and large geographical spread of NICUs as well as families.ConclusionIn conclusion, the protocol seem to be feasible and appreciated by parents in the target group. With regard to the small recruitment base, trials of this kind needs a long inclusion time. Since EPT-children and their parents displays a wide scope of difficulties and challenges, multi-professional cooperation is preferable, placing high demands of sensitivity, professional respect and time for long collaborative processes.
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- Baraldi, Erika, 1982-, et al.
(författare)
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Early intervention program of extreme preterm born infants, status report three years into the project
- 2021
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Children born extremely preterm (e.g. before 28 gestational weeks, EPT) runs a greater risk of cognitive, motor and neurobehavioral impairment later in life, compared to children born at term. Moreover, being a parent of an EPT born child increases the probability of developing depression and posttraumatic stress disorder post-partum, as well as the premature birth may affect the parent-child interaction negatively. In an attempt to decrease the psychological and motoric negative impact of both the child and parents, our multi-professional team has developed an early intervention during the first year at home focusing om parent-child interaction of the EPT born children: Stockholm Preterm Interaction-Based Intervention, SPIBI (Baraldi et al., 2020a). The target of the RCT is 130 children and after 32 months 112 children has been included in the study, evenly distributed in the intervention group and control group. At children’s corrected age of one-year, parents from 14 of the first included families were interviewed about their experiences from the intervention program, resulting in a qualitative article. Three main themes of parental experiences of the first year at home emerged: child-related concerns (concerning child medical state, self-regulation and recovery), parental inner state (concerning loneliness, ambivalence and premature parental identity), and changed family dynamics (concerning the couple, siblings and intergenerational support). The parents from the intervention group reported that the intervention had given them security, a sense that the interventionist has been knowledgeable and in some cases that the program was important but not necessary to them (Baraldi et al., 2020b). With 85% of the targeted subjects included it is clear that an extensive early home-visit intervention program is feasible in the Swedish context, even though the pandemic has slowed down the recruitment pace and has forced adjustments to be made such as the use of telemedicine, exclusion of toys in the follow-up process and intensified hygienic procedures.
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- Baraldi, Erika, 1982-, et al.
(författare)
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Erfarenheter & utmaningar vid prövning av ett hembesöksprogram för extremt prematurfödda barn och deras familjer
- 2023
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Ingår i: Abstracts CKVO Konferens 11-12 maj. ; , s. 20-21
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund: Stockholm Preterm Interaction-Based Intervention (SPIBI) är ett nytt styrkebaserat tidigt interventionsprogram för samspelsstöd till föräldrar och barn i familjer där barnet föddes mer än tre månader för tidigt. Forskning visar att dessa barn löper ökad risk att stöta på problem i sin utveckling vad avser kognition, koncentrationsförmåga, skolgång och social situation. Det finns också ökad risk för att föräldrarna ska drabbas av psykisk ohälsa. SPIBI består av 10 hembesök under första året hemma, där fokus ligger på att stärka ett lyhört föräldra-barn samspel, bejaka lekfullhet och stötta barnets nyfikna utforskande. 130 extremt prematurfödda barn från 122 familjer har rekryterats och randomiserats till interventionsgrupp (n=66) och kontrollgrupp (n=64). Studien är i linje med FNs globala hållbarhetsmål för god hälsa och välbefinnande samt minskad ojämlikhet då den riktar sig till en grupp som riskerar drabbas av ohälsa och utsatthet även i vår kontext, med tillgång till avancerad neonatalvård och utbyggd välfärd.Syftet med detta bidrag är att redovisa erfarenheter av interventionens genomförande i hemmiljö från oktober 2018 till december 2022. Metod: Samtliga intervenerare (n=6) och 17 av de deltagande föräldrarna har intervjuats om sina erfarenheter från SPIBI. Föräldraintervjuerna är tidigare publicerade (Baraldi et al., 2020).Resultat: Deltagande familjer varierar mycket vad avser barnens medicinska behov, hur svår sjukhusvistelse familjen har bakom sig, familjens socioekonomiska situation och tidigare föräldraerfarenhet. Vissa familjer har dubbel belastning både i form av kvarstående behov av frekventa sjukhusbesök efter ett års ålder, och utsatt familjesituation med exempelvis trångboddhet, otrygg boendemiljö eller bristande socialt nätverk. Således varierar också behoven som familjerna önskar få tillfredsställda av interventionsprogrammet, från utökat behov av stöd i att läsa barnets signaler till behov av socialt stöd i föräldrarollen. De familjer vars barn har störst funktionsnedsättning är inte nödvändigtvis i störst behov av SPIBI, eftersom de ofta redan har extra vårdkontakter. Coronapandemin drabbade deltagande familjer hårt, då hygienfrågor alltid är viktiga i omsorgen om svårt sjuka barn. Detta påverkade i sin tur SPIBI både avseende hembesöksmodellen och rekrytering. Trots olika förutsättningar uppger samtliga behandlare att det varit lätt att hitta styrkor att fokusera på i familjerna och att hembesöksupplägget överlag fungerat väl.Slutsats: Implementeringen av SPIBI under studieperioden har fungerat väl, men delvis störts av pandemin. Framtida vidareutveckling av SPIBI skulle kunna inkludera en flernivåmodell, där stödets intensitet men även fokusområden anpassas till den enskilda familjen.
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| 9. |
- Baraldi, Erika, 1982-, et al.
(författare)
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Home-visits during the first year of life : a strengths-based intervention for extremely premature infants and their parents, a randomized-control trial developed in Stockholm Region
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In Sweden 400 children yearly are born extremely preterm (EPT; more than three months early). These children have an increased risk of later academic difficulties, neuropsychiatric disorder, cognitive and mental health issues. Since the first 1000 days of the brain development are so crucial for later development, the interdisciplinary Stockholm Preterm Interaction-Based Intervention (SPIBI) aims at strengthening the parent-child interaction, child development and parental mental health. The research is based on pedagogical, motor-developmental, medical and psychological science. The program is based on Vygotski’s theory of the zone of proximal development, as well theoretical frameworks of early intervention (Guralnick; Shonkoff). Additionally, Als’ synactive theory of understanding premature infant communication and needs, Bowlby’s attachment theory, and Emde’s emotional availability theory have been applied. SPIBI is an ongoing research project funded by Stockholm-County-Stockholm-University joint-collaboration grant 20160881. It is an RCT targeting 130 EPT infants and their parents in Stockholm with a 3-year inclusion period starting September 2018. The intervention consists of ten home-visits during the first year by trained interventionists, supporting the next developmental step of the child through a scaffolding process, strengthening parental sensitivity to infant cues, and promoting infant’s self-regulation. SPIBI has recruited and trained six multi-professional-NICU-experienced interventionists. Control group participants receive TAU plus an extended follow-up program.The overall aim is to present the framework and theory of change of SPIBI, relating to research findings, welfare policies and recommendations for infant’s “chain of care”. So far, sixty eligible infants have been identified within four neonatal units; of which 48 approved participation. The primary outcome is emotional availability of the parent and child, where we hypothesize that the intervention will affect the parental sensitivity and structure of interaction with the child. Secondary outcomes concern child development, i.e. motor development, cognition and occurrence of neuropsychiatric symptoms, parental mental health, anxiety and self-efficacy, where we also hypothesize positive effects of the intervention. Since Nordic countries have neonatal intensive care of high quality, the amount of EPT survivors is high compared to other countries; therefore, the educational systems must follow achievements reached by health care system and develop new evidence-based interventions in early childhood education, which are appropriated for EPT born children and their parents, following recent European Standards of Care for Newborn Health (2018).Insights from neuro-cognition, early intervention and educational research has shown the importance of interdisciplinary interventions, and this should be spread around the Nordic countries.Nordic countries offer a unique social environment, with governmental funded parental-leave, enabling early-interventions delivered by parents.The EPT children in Nordic countries are less affected by socioeconomic factors, as is often the case where maternity welfare and obstetrics is not publically financed. Hence, Nordic countries have a unique opportunity to perform research targeting EPT students and their parents specifically, with less confounding factors.Some Nordic countries have adopted policies concerning home-visiting support and infants’ rights, as recommended by the World Association of Mental health’s policy statement from 2016, and Nordic knowledge exchange and collaboration on these policies is warranted.
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