720 - Stakeholder Perspectives on Standardized Screening and Referral Interventions for SDOH in the NICU: An Implementation Science Approach

Publication Number: 720.6594

Qais Karim, Joseph M. Sanzari Children's Hospital Hackensack University Medical Center, New York, NY, United States; Sandhya Brachio, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Although the AAP recommends universal screening for social determinants of health (SDOH) and referrals for unmet basic needs, only ~23% of NICUs currently implement such screenings. Research highlights a need for standardized SDOH assessment and referral interventions in NICUs, especially given disproportionately higher prevalence of low-income and racially minoritized families in the NICU.

Objective: We sought to examine the feasibility and acceptability of implementation of recently implemented hospital-wide SDOH screening and referral interventions in our NICU from the perspective of key stakeholders, and to identify factors affecting implementation outcomes.

Design/Methods: We performed 12 semi-structured interviews with key stakeholders in our 75-bed level IV NICU in New York City. We utilized the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework to guide interview questions, and deductive approach for codebook development for directed content analysis. Each interview was recorded via Zoom, transcribed verbatim, and coded by 2 team members using thematic analysis. Themes and sub-themes that emerged were mapped onto the 4 EPIS domains (outer context, inner context, innovation factors, and bridging factors).

Results: Interviews included 22 participants (nurses, advanced practice providers, social workers, case managers, neonatology fellows and attendings, parents of NICU infants) (Table 1). Qualitative analysis resulted in 23 themes among 12 of 16 EPIS constructs within the outer context (n = 10), innovation factors (n = 7), and inner context (n = 6) (Table 2).

Conclusion(s): We identified themes across three of four EPIS domains affecting the implementation outcomes of an SDOH screening and referral intervention in the NICU. Most stakeholders recognized the importance of standardized interventions and acknowledged a high prevalence of unmet basic needs. However, aside from social workers and case managers, most were unaware of existing hospital-wide processes. Concerns were raised about inadequate resource allocation for these interventions. Social workers felt current referral methods did not adequately address patients’ needs, while parents faced significant barriers to being present in the NICU, emphasizing the need for better screening and referral to support their involvement. Neonatology fellows also stressed the importance of providing resources for families. Our study uniquely captures diverse stakeholder perspectives, including parents, in an urban level IV NICU, offering insights to enhance the sustainment of screening and referral interventions.

Table 1
Characteristics of interview participants

Table 2
Interview themes and supporting quotations organized by EPIS domains and constructs

Table 1
Characteristics of interview participants

Table 2
Interview themes and supporting quotations organized by EPIS domains and constructs