Safety Net Access Program at Sharp Mary Birch Hospital for Women & Newborns
Grant Status: Active
Training Category: Healthy Tomorrows Partnership for Children Program (HTPCP)
Project Director(s):
Rebecca Dorner, MD
Sharp Mary Birch Hospital for Women & Newborns
San Diego, CA 92123
Phone: 858-939-4170
Email: rebecca.dorner@sharp.com
Problem:
After NICU discharge, infants may be medically fragile with complex problems and require close neurodevelopmental follow-up. SMBHWN remains focused on improving the long-term outcomes of premature infants as they are at greatest risk for medical, developmental, and behavioral problems. Prematurity tremendously increases the risk of newborn brain injury and therefore, babies who are born prematurely have much higher rates of death, developmental problems, and cerebral palsy. Ensuring the neurodevelopmental needs of premature babies are assessed as they grow and turn two is critical for their physical growth, mental health, and emotional well-being. To ensure critically ill infants discharged from the NICU have increased access to much needed follow-up services, SMBHWN established a high-risk infant follow-up (HRIF) clinic in 2017.
Goals and Objectives:
The goal of the Safety Net Access Program (SNAP) is to increase access to neurodevelopmental follow-up visits at 6-months, 12-18 months, and 22-24 months for infants and children at the greatest risk for medical, developmental and behavioral problems. This program will target low-income, medically uninsured and underserved families served by SMBHWN to promote kindergarten readiness at 5 years of age. Specific attention will be given to families with limited mobility and transportation challenges through a grant-funded family transportation assistance fund.
Methodology:
At each Clinic follow-up visit, pediatric nurse practitioners, a social worker, a medical assistant, and support staff perform a physical exam and offer age-appropriate developmental educational resources for each child. A neurological exam is also performed to assess for cerebral palsy. The team assesses cognitive, language, social, as well as fine and gross motor skills and makes appropriate referrals to make sure the child stays on track during the first years of life to ensure school-readiness. The Clinic team collaborates with the child's family, pediatric primary care provider and other specialists for early interventions and comprehensive care.
Coordination:
Clinic staff engage mothers at risk for a preterm birth by providing education and support resources the high-risk pregnancy unit at the hospital. During hospitalization, the Medical Director and/or the Clinic staff or NICU Case Manager meet with parents to provide an overview of the Clinic when their newborn is admitted into the NICU and to help them understand what resources the Clinic can provide. After hospital discharge, Clinic staff will outreach to families to ensure close follow-up services. The first visit occurs at six months following NICU discharge, and a minimum of two more clinic visits thereafter are scheduled until age three to ensure each child reaches their highest developmental potential and can be mainstreamed into public schools.
Evaluation:
A neurodevelopmental follow-up database using a web-based cloud platform is used to compile patient data that will be used for analysis purposes. This database can be used by clinicians and staff for determining areas that need of improvement such as certain demographics or populations that have had abnormal outcomes. This data can also be used to publish and disseminate outcome data for potential therapies that may have favorable long-term outcomes.