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Family + Home Needs Assessment
Social Support
social support

WHO is THEIR COMMUNITY

Evaluate what social supports the family has in place (or anticipates will be in place) at discharge.

Explore how they feel about asking for and receiving support.

Identify what kinds of support they may still need. 

Also, ask how they feel about the quality of support they receive. 
 

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coping
Family Coping Style

ADAPTING and COPING

Learn about the family’s coping habits and styles.


Offer supportive resources.
 

Mental Health
mental health wellbeing

MENTAL HEALTH and WELLBEING

Perinatal mood and anxiety disorders (PMADs) are common and treatable, but may be missed if not specifically assessed.

Mental health issues may look different in birthing parents than in their partners or spouses.
 
Mental health manifestations may also vary based on cultural or social context.
 
When screening a family, be sure to use evidenced based cut off scores for the individuals being screened (e.g., partners, those impacted by racism, etc.).
 
Families with limited English proficiency may require a more specific mental health assessment and/or support.

NOTE:  Every family who requests mental health support should receive mental health support, regardless of the scores on their assessments.

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Assess parents for mental health complications in the NICU and in corporate the results into the discharge planning. 

All parents need mental health support. However, this is especially important for those with an existing diagnosis or a known history of perinatal mental health complications, including postpartum depression (typical and atypical), anxiety, and post-traumatic stress.

Request a mental health assessment if there is concern about the parents’ bonding or attachment with the infant.

Any assessment should be done with consent, should be informed by parent report, and should based on the observed behavior.

Provide parent-infant mental health support.



SEE NPA's Interdisciplinary Recommendations for the Psychosocial Support of NICU Parents
and Recommendations for Mental Health Professionals in the NICU

 

Social and Safety Concerns
safety

CREATING SAFETY

Develop safety plans in collaboration with the family when there are social and/or safety concerns.

Assessment of the family should include screening for interpersonal violence and parental substance misuse when they present significant unmanaged risks and when there are no protective factors.

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UNDERSTANDING and REDUCING RISKS

Some families will be considered high-risk and may need extra attention and support as part of the discharge planning process.

NOTE:  While there may be things that put a family at-risk, there are also protective factors that reduce or mitigate those risks. For example, if a mother is substance-dependent but is also receiving medication to treat that substance dependence their engaging with medical care is a protective factor. 

Some examples of factors that can cause families to be labeled high-risk include, but are not limited to:

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  • active substance misuse or a medical history of substance misuse, without protective factors

  • inadequate prenatal care or inadequate access to prenatal care

  • being a teenage parent

  • experiencing interpersonal violence

  • experiencing housing or food insecurity

  • significant relationship instability

  • diagnosed or undiagnosed mental health conditions, without protective factors

  • limited socioeconomic resources

  • low functional health literacy

  • incarceration or involvement with the carceral system

  • insecure legal or citizenship status, which can be the case for transient or migratory families

 

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NOTE:  The reason a family is high-risk and how that information was discovered should be treated as private and sensitive information.

 

This means that access to the information should be limited to those who need to know.

 

To the extent possible, there may need to be an assurance of professional confidentiality so that families feel comfortable disclosing information.

 

If information can be used to potentially cause harm, such as a disclosure of substance use or the sharing of a family's immigration status, families should be advised of the risks of disclosure and every effort should be made to limit the harm that the sharing of this information may lead to.

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IMPORTANT:  If they are going to provide ethical care, staff should be aware of their own explicit and implicit biases and try to minimize their influence on the family and home assessment process.



A documented system of early intervention referral and communication with community resources is needed for babies going into foster or custodial care.

 

Where are they living? Are their housing needs met?

Does the family have what they need to care for their baby?

Does the family have safe, adequate housing?

Can the family get where they need to be reliably?

Who are the members of their caregiving team?

Does the family need help getting the food they need?

Who is a part of their community? Where do they find help? 

How do they handle stressors? Do they need more support?

Do they have the mental health support they need?

What do they need for them and their baby to be safe?

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