Maternal, Infant, and Early Childhood Home Visiting Program

For the audio discussion board, you will be reviewing a case study on pages 114-116 of your text. The case study follows parents Jessica, Travis and their newborn son, Eric who was born prematurely. Due to his premature birth, Eric remained in the hospital, in the Neonatal Intensive Care unit (NICU) for 5 weeks. After you thoroughly review the case study, you will watch a video that describes the Maternal, Infant and Early Childhood Home Visiting Program. Home visiting programs allow human service professionals to not only assess their clients, but to see them in their home environment, which will highlight strengths and areas where resources and support might be needed. Imagine that you are a home visitor and have been assigned to Jessica, Travis and Eric. You have scheduled an appointment to visit them the week after Eric is released from the NICU.

Please answer the following questions:

What are your top three concerns regarding this family? Discuss each concern.

What 3 questions would you like to ask Jessica and Travis?

Describe at least 1 resource that you would recommend for this family. Discuss how the resource will benefit the family.

Discuss two ways that a home visiting program would benefit this family.

RESOURCES

TEXTBOOK:

Empowerment Series: Human Behavior in the Social Environment: A Multidimensional Perspective

Jose B. Ashford.

PAGE: 114

APPLYING THE FRAMEWORK

THE FAMILY OF A PREMATURE INFANT*

Jessica and Travis asked to see the hospital social worker to discuss their concerns about their 2-week-old infant, who was in the hospital NICU. The baby had been born 9 weeks premature. The couple was displaying some fear and apprehension in interacting with their baby during his stay in the NICU. They were apprehensive about their ability to parent their infant and worried about how they would ever be able to care for the baby on their own at home. They also were concerned about future developmental problems for their child.

Developmental History

Travis and Jessica had been attempting to have a baby for several years. Two previous pregnancies had ended in miscarriage. Fifteen months after her last miscar- riage, Jessica became pregnant for the third time. She did not use alcohol or drugs during the pregnancy, but she did continue to smoke. After learning she was pregnant, though, she had managed to cut down to four or five cigarettes per day. Preterm labor began for Jessica in week 26 of her pregnancy, and she was placed on bed rest and medications at home to stop her labor. Several weeks later, her cervix started to dilate, and she was hospitalized in the high-risk obstetrics unit for the duration of the pregnancy. Eric was born at 31 weeks’ gestation and weighed 1,134 grams (2 lb. 8 oz.). The Apgar scores were 6 at 1 minute and 7 at 5 minutes. Immediately after birth, Eric began to experience respi- ratory distress. After a brief viewing by his parents, he was transferred to the NICU.

Biophysical Considerations

On admission to NICU, Eric was placed under an oxy- gen hood. He required cardiac and respiratory mon- itoring. Because he was too small to maintain his body temperature, he was placed in an incubator. He required intravenous lines for maintaining fluids and administering medications. Eric’s very low birth weight and gestational age placed him at potential risk for con- tinued respiratory difficulty, anemia, infection, intra- ventricular hemorrhage, jaundice, and retinopathy of prematurity.

Fortunately, Eric’s condition improved quickly. His lungs were mature enough for his need for

supplemental oxygen to end when he was removed from the oxygen hood 3 days after birth. He then developed jaundice (hyperbilirubinemia), which was successfully treated with phototherapy (being placed under lights). Because he was born before his sucking reflex was well established, he required oral gavage feedings. Eight days after birth, he was transferred to the area of the NICU for “growing preemies,” where he would remain until he had developed coordination to nipple- or breastfeed and had gained enough weight for discharge home.

Psychological Considerations

Jessica and Travis reported that, on entering the NICU for the first time, they found themselves totally unprepared for the sight of their baby. Alongside the machines and other technology, he appeared weak and vulnerable. Travis described his thoughts on that day: “We had lost control of the situation and felt completely intimidated. There were machines every- where, and he just looked so small.”Travis and Jessica began to worry about possible complications for their baby. As do many families faced with high-risk peri- natal situations, Jessica and Travis became focused on possible medical outcomes instead of on their new baby.

Worry and uncertainty over their child’s fate began to interfere with parental attachment and bonding. Jessica and Travis found it difficult to bond with a baby they feared might die or be severely handicapped. Jessica described her bonding process with Eric as a roller-coaster ride.“I loved him, but it felt like a risk.”

Jessica felt that she did not know her infant—that she had lost control of the baby to the NICU staff. She felt inadequate and incompetent in her ability to care for her very ill child. Jessica remembered those early moments following Eric’s birth.“He was taken away so quickly, and we had no idea where they were taking him. I looked at Travis and started crying. It wasn’t what we expected.”Just minutes after finally becoming a new mother, Jessica had relinquished her role of primary caregiver to the nurses and medical staff. This feeling was further reinforced when Jes- sica attempted to hold her baby. He slept most of the time, and when he was awake he was irritable. When Jessica held him, he would cry, put up his hands, and turn away from her. Jessica felt that the baby was rejecting her.

Social Considerations

Family Situation

Jessica and Travis were in their mid-20s and had been married for 6 years. Travis worked as a manager in a supermarket. Jessica worked as a medical transcriber in a hospital. They recently had purchased their first home. Jessica had planned to take 3 months off from work to care for her new baby, but because she was on bed rest for 5 weeks before the birth and had been visiting her baby in NICU daily since his birth, Jessica already had used up half of her maternity leave. She was afraid of losing her job, but she did not see how she could return to work full time with such a small baby to care for. Yet the couple did not believe they could make their mortgage payments on just Travis’s salary. They had little savings. There was a possibility that Jessica could work part-time and perhaps do some transcription at home.

Jessica’s parents lived in town, and she reported having a warm and close relationship with them. Her mother had expressed a desire to help with the baby’s care, but because of back problems her participation would be limited. But her mother stated she might be able to come and watch the baby while Jessica worked at home.

Groups, Communities, and Social Support Systems

Travis and Jessica attended a Methodist church in their neighborhood. Many church friends and neighbors had offered support and prepared meals for them through- out the past 6 weeks. Jessica’s friends from work had also helped out by throwing a baby shower a few days after the baby’s birth and providing her with needed baby items.

The community in which the couple lived provided an early intervention program for low-birth-weight babies. The program offered weekly in-home visits, as well as regular developmental follow-up in a clinic.

Summary and Impressions

1. The assessment showed that this family had the following problems:

2. Low-birth-weight infant because of prematurity 3. Medical complications of hyperbilirubinemia and respiratory distress with need for supplemental

oxygen 4. Problems with parent–infant interactions 5. Unknown long-term prognosis for the infant 6. Family financial problems

Looking at the couple’s strengths and resources showed that they had a stable home life with an ade- quate environment for a low-birth-weight baby. They had family and friends who were supportive and car- ing. The parents were interested in and willing to be involved in learning to care for and interact with their infant. The hospital staff was very supportive of the new parents and willing to be involved in enhancing positive parent–infant interactions. The community provided an early intervention program for parents of low-birth-weight infants.

After meeting with the social worker, Jessica spent time every day with Eric, initially just observing others caring for him. His primary nurse explained his capacity for interaction,“time out”signals, proper handling, and positioning. The nurse showed Jessica how to swaddle the baby and hold him quietly for a feeding. She taught Jessica to wait until the baby began to look around searchingly before trying to make eye contact and talk to him. The nurse explained that when Eric held up his hand and spread his fingers, he was signaling that he was tired and needed some time alone. Given information and support from the nurses and from the social worker, Jessica was able to interact positively with her infant.
As time went by, both parents learned about and participated in Eric’s care. Their involvement helped establish and enhance their bond to the baby. They kept a calendar of events and took photos of Eric’s days in the NICU—the transition from incubator to open crib, first tub bath, and first attempts at feeding. Thus, they were able to share their tiny son’s struggles and accom- plishments with friends and family.

After 5 weeks in the hospital, Eric weighed 1,843 grams (4 lb. 1 oz.), was breastfeeding well, and was ready to go home. Jessica and Travis were ready to accept the responsibility for him at home, but the excitement of

discharge was still tempered with apprehension about the transition. The long-term effects of the baby’s prematurity were still unknown. And though they were now indepen- dent in their caring for Eric, they still felt“dependent on the NICU staff for backup.” They admitted to still feel- ing a bit incompetent and unsure of their ability to ade- quately care for their small son. Travis recalls that“leaving the hospital was almost as stressful as being there, but we were glad to be taking our baby home. Finally!”

Cathy Jaworski, R.N., provided information for this case.
References:

HRSAtube. (2018, September 27). HRSA's Maternal, Infant, and Early Childhood Home Visiting Program [Video]. YouTube.