Q&A/Ask the Expert: Neonatal Therapy: An Emerging Practice Area

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By: Sandra Carroll, OTR, CIMI & Chrysty Sturdivant, OTR
Neonatal Therapy Solutions

What is Neonatal Therapy?
Neonatal Therapy is the implementation of specialized skills and advanced knowledge in the assessment, planning and treatment of a variety of medical conditions specific to premature and medically fragile infants. In a nutshell, the goal is to maximize developmental outcomes and support infant-parent relationships, contributing to the infant’s success in life as a unique individual.

What is a Neonatal Therapist?
A Neonatal Therapist is an Occupational or Physical Therapist or a Speech Language Pathologist who provides direct patient care and/or consultative services for the premature and medically complex infants in a Neonatal Intensive Care Unit (NICU).

Using an integrated, family-centered model, Neonatal Therapists provide highly specialized and individualized therapeutic interventions that facilitate the prevention of adverse sequela due to prematurity and/or prolonged hospitalization.

Is a Neonatal Therapy model similar to pediatric rehabilitation model of treatment?
No, the model for practice in a NICU is not rehabilitative as seen in the pediatric setting. A traditional rehabilitation model of therapy is based on developmental stimulation, with a problem-based referral system. Therapy is typically direct and hands-on with a focus on performance as a indicator for progress. For example, a child may seek a pediatric PT for treatment of a club foot. A treatment plan would be established with hands on manual therapy and possible splinting or casting.

In an integrated model, the trained Neonatal Therapist is assigned dedicated time in the NICU with a preventive approach to care. Treatment may include consultation and/or direct care. A protective treatment approach is indicated for the hospitalized premature infant due to the fact they have inherent developmental risks. The infant and family require the support of the Neonatal Therapist throughout the hospital stay. The Neonatal Therapist must gain trust, acceptance and respect from the families and the NICU team in order to develop a partnership for a holistic treatment approach. An example of treatment in an integrated model of treatment would be a nurse requesting a therapist to meet with a family and discuss their 24 week premature baby’s developmental competencies and what the family can “do” at the bedside to connect or bond with their baby.

How can an OT, PT, or SLP begin a career in Neonatal Therapy?
Well, first of all, the quite obvious answer is: Get a job where there is a NICU! You cannot become a Neonatal Therapist if you are working in an outpatient hand clinic or a skilled nursing facility. NICUs are typically housed in larger hospitals with acute care services, or at children’s hospitals. But there is much more than being employed in a hospital with a NICU.

It is important for therapists desiring to move into this area of specialty to know what “level” of neonatal care is offered in their hospital. Levels are determined by what services and care are provided by each NICU. A Level II NICU is one that provides services above the basic care of the “regular” newborn nursery, like antibiotic therapy or supplemental oxygen. A Level III NICU includes multiple disciplines who specialize in intervention specifically with preterm infants or infants with medical conditions requiring intensive care. Level III NICUs will offer life-saving support services and interventions such as prolonged mechanical ventilation, and surgical services.

Level IV NICUs will offer services not provided by others in the region, such as ECMO (Extra Corporeal Membrane Oxygenation). There are not many Level IV NICUs in the country. Professionals working Level III/IV NICUs are usually “dedicated” to the unit, meaning that they rarely cover other hospital units, so that the team can become cohesive and excel in the care of these high risk infants. The multidisciplinary team will commonly include the following professionals: OT/PT/ST; Dietitians; Family Care Coordinators; NICU Nurses; Nurse Educator; Advanced Nurse Practitioners (either a Pediatric or Neonatal Nurse Practitioners); Neonatologists; Lactation Consultants; Respiratory Therapists; Pharmacists; Chaplains; Social Workers (long live the social workers!), and other mental health professionals.

If a hospital offers only services for “regular” newborns (Level I), a therapist may be consulted to provide therapeutic intervention for diagnoses such as cleft lip/palate; Down syndrome; or brachial plexus injuries. Usually these consults are few and far between, and will not require a dedicated professional to be housed in this unit part/full time. If you are working in a hospital with a newborn nursery, it would be beneficial to have someone with knowledge and skills in pediatric intervention to establish a relationship with the management staff, and to come up with a plan for coverage of these infants. This would be one step towards moving towards becoming a Neonatal Therapist.

What basic skills and knowledge should a Neonatal Therapist possess?
American Occupational Therapy Association (AOTA), American Speech Language Hearing Association (ASHA), and American Physical Therapy Association (APTA) all have position papers clearly stating the knowledge and skills required for practice in the NICU. Practice in the NICU is not for entry-level therapists. AOTA/ASHA/APTA all state that a therapist should possess a minimum of 2 years of pediatric practice before entering work in this high-risk area. However, in many NICUs across the country, there are therapists who are lacking this experience.

It is not uncommon for therapists with limited pediatric experience to struggle with establishing their credibility, and can, quite possibly, unintentionally be putting infants at risk. It can also be hazardous to the security of one’s professional license.

Basically speaking, one must be well-versed in the following areas: embryology; human development; family systems; psychosocial interventions; maternal/fetal medicine & obstetrics; sensory integration; neuromuscular and neurodevelopmental interventions; musculoskeletal interventions; as well as feeding and oral motor skill development and treatment.

How can I obtain the knowledge I need to become a Neonatal Therapist?
It would be helpful to first gain pediatric (specifically 0-3) experience, so obtaining a job with this intention would be the first step. The next step would be to attend continuing education courses and/or find a designated mentor who can coach you along. Also, Neonatal Therapy Solutions is an education and consultative business especially designed for you who are interested in this field! Together, Sandra and Chrysty have 48 years of experience and have practiced in several level III NICU’s in the Dallas, Texas area. Due to popular request, they have designed workshops, consultative and mentorship services for therapists and/or NICU caregivers who desire to improve their skills and knowledge. You may visit their website at www.neonataltherapysolutions.com and contact them to learn more about their programs.

Are there any groups or organizations I could join?
Yes! The National Association of Neonatal Therapist was founded in 2009, by Sue Ludwig, OTR/L. We encourage you to visit the website www.neonataltherapists.com to learn how to become a member and join today! There are many benefits to becoming a member, including monthly mentoring conference calls, special topic calls and regularly published newsletter/notes all pertaining to the emerging practice of Neonatal Therapy. Join this group of highly motivated and passionate therapists.

What else do I need to know about becoming a Neonatal Therapist?
It is important to let others know about your desire and state your intentions to become a therapist in the NICU. Supervisors, managers, colleagues, mentors, friends and family, could all have leads of which you are unaware.

More importantly, passion is necessary. Passion will fuel you to get through the difficult transition from pediatric therapist to Neonatal Therapist. Passion will be most helpful to press through all of the outside reading required to obtain the knowledge and confidence to propel you forward into an area of specialty practice. Passion will help you to become the therapist that touches the lives of infants and families who will be forever grateful for your presence in that NICU.

Contact us:
You can visit www.neonataltherapists.com to obtain more information on the AOTA/ASHA/APTA position papers, as well introductory courses offered to increase knowledge to move you forward to a career as a Neonatal Therapist.

This Month’s Featured Authors: Sandra Carroll, OTR/l, CIMI and Chrysty Sturdivant, OTR/L

Neonatal Therapy Solutions was created to guide neonatal therapists and other healthcare professionals to become excellent clinicians in the NICU. The company offers flexible education packages and consulting services for the NICU. In addition, personalized mentorship programs can be custom designed for individuals or groups.

Sandra Carroll and Chrysty Sturdivant, co-founders of Neonatal Therapy Solutions, are both occupational therapists who specialize providing services in the NICU. Together, they have 50 years of experience in treatment and intervention of high risk infants/families. Sandra and Chrysty are nationally recognized speakers, educators and mentors. Their dedication and passion for the advancement of neonatal therapy is exemplary.

Please support our contributing authors and organizations – visit Neonatal Therapy Solutions

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