Download PDF
Am J Perinatol 2024; 41(03): 317-329
DOI: 10.1055/a-1678-0002
Original Article

Neonatal Therapy Staffing in the United States and Relationships to Neonatal Intensive Care Unit Type and Location, Level of Acuity, and Population Factors

Roberta Pineda 
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
2   Department of Pediatrics, Keck School of Medicine, Los Angeles, California
3   Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California
4   Program in Occupational Therapy, Washington University, St. Louis, Missouri
,
Julia Lisle
1   Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
,
Louisa Ferrara
5   Department of Pediatrics, NYU Langone Hospital - Long Island, Mineola, New York
6   Department of Communication Sciences and Disorders, Molloy College, Rockville Centre, New York
,
Kati Knudsen
7   Neonatal Intensive Care Unit, Women's and Children's Division, Providence St. Vincent Medical Center, Portland, Oregon
,
Ramya Kumar
8   Department of Rehabilitation Services, Banner Thunderbird Medical Center, Glendale, Arizona
,
Alicia Fernandez-Fernandez 
9   Physical Therapy Department, Dr. Pallavi Patel College of Health Care Sciences, Nova Southeastern University, Fort Lauderdale, Florida
10   Neonatal Intensive Care Unit, Rehabilitation Department, South Miami Hospital, Miami, Florida
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Objectives This study aimed to (1) estimate the total pool of neonatal therapists (occupational therapists, physical therapists, and speech-language pathologists who work in the neonatal intensive care unit [NICU]) and the average number represented in each U.S. based NICU, and (2) investigate the relationships between the number and type of neonatal therapy team members to NICU/hospital, population, and therapy factors.

Study Design This study used several methods of data collection (surveys, phone calls, and web site searches) that were combined to establish a comprehensive list of factors across each NICU in the United States.

Results We estimate that there are 2,333 full-time equivalent (FTE) positions designated to neonatal therapy coverage, with 4,232 neonatal therapists covering those FTEs. Among 564 NICUs with available neonatal therapy staffing data, 432 (76%) had a dedicated therapy team, 103 (18%) had pro re nata (as the circumstances arise; PRN) therapy coverage only, and 35 (6%) had no neonatal therapy team. Having a dedicated therapy team was more likely in level-IV (n = 112; 97%) and -III (n = 269; 83%) NICUs compared with level-II NICUs (n = 51; 42%; p < 0.001). Having a dedicated therapy team was related to having more NICU beds (p < 0.001), being part of a free-standing children's hospital or children's hospital within a hospital (p < 0.001), and being part of an academic medical center or community hospital (p < 0.001). Having a dedicated therapy team was more common in the Southeast, Midwest, Southwest, and West (p = 0.001) but was not related to the proportion of the community living in poverty or belonging to racial/ethnic minorities (p > 0.05). There was an average of 17 beds per neonatal therapy FTE, a good marker of therapy coverage based on NICU size. Three-hundred U.S. based NICUs (22%) had at least one Certified Neonatal Therapist (CNT) in early 2020, with CNT presence being more likely in higher acuity NICUs (59% of level-IV NICUs had at least one CNT).

Conclusion Understanding the composition of neonatal therapy teams at different hospitals across the U.S. can drive change to expand neonatal therapy services aimed at optimizing outcomes of high-risk infants and families.

Key Points

  • We estimated that there are 4,232 neonatal therapists working in NICUs in the United States.

  • Dedicated therapy teams for the NICU are more common in large, high acuity NICUs.

  • An average of 17 beds per neonatal therapy FTE was observed.

  • In 2020, 22% of NICUs had CNTs, and CNTs were more common in large and high acuity NICUs.

  • Benchmarking neonatal therapy staffing can aid in expanding NICU therapy services where needed.

Keywords

disparity - health care access - development - occupational therapy - physical therapy - speech-language pathology - certification - outcomes - environment


Publication History

Received: 04 June 2021

Accepted: 20 October 2021

Accepted Manuscript online:
25 October 2021

Article published online:
14 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Craig JW, Smith CR. Risk-adjusted/neuroprotective care services in the NICU: the elemental role of the neonatal therapist (OT, PT, SLP). J Perinatol 2020; 40 (04) 549-559
    Google Scholar
  • 2 Pineda R, DeGaetano S, Kindra M. et al. Neonatal therapy: a survey of current practice. J Pediatr Rehabil Med 2019; 12 (03) 285-294
    Google Scholar
  • 3 Sweeney JK, Heriza CB, Blanchard Y, Dusing SC. Neonatal physical therapy. Part II: practice frameworks and evidence-based practice guidelines. Pediatr Phys Ther 2010; 22 (01) 2-16
    Google Scholar
  • 4 Sweeney JK, Heriza CB, Blanchard Y. American Physical Therapy Association. Neonatal physical therapy. Part I: clinical competencies and neonatal intensive care unit clinical training models. Pediatr Phys Ther 2009; 21 (04) 296-307
    Google Scholar
  • 5 Vergara E, Anzalone M, Bigsby R. et al; 2005 Neonatal Intensive Care Unit Task Force. Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit. Am J Occup Ther 2006; 60 (06) 659-668
    Google Scholar
  • 6 Knowledge and skills needed by speech-language pathologists providing services to infants and families in the NICU environment. Accessed November 11, 2021 at: https://www.asha.org/policy/ks2004-00080/
    Google Scholar
  • 7 National Association of Neonatal Therapist. Neonatal therapy core scope of practice. Accessed November 11, 2021 at: https://neonataltherapists.com/resources
    Google Scholar
  • 8 Neonatal Therapy Certification Board. 2021 ; Accessed November 11, 2021 at: https://neonataltherapycertification.com
    Google Scholar
  • 9 Kilpatrick SJ, Papile L-A, Marcones GWatterberg KL. eds. Guidelines for Perinatal Care. Vol. 8. Elk Grove Village, IL: American Academy of Pediatrics; 2017
    Google Scholar
  • 10 Crilly CJ, Haneuse S, Litt JS. Predicting the outcomes of preterm neonates beyond the neonatal intensive care unit: what are we missing?. Pediatr Res 2020; 89 (03) 426-445
    Google Scholar
  • 11 Cheong JLY, Burnett AC, Treyvaud K, Spittle AJ. Early environment and long-term outcomes of preterm infants. J Neural Transm (Vienna) 2020; 127 (01) 1-8
    Google Scholar
  • 12 Sturdivant C. A collaborative approach to defining neonatal therapy. Newborn Infant Nurs Rev 2013; (13) 23-26
    Google Scholar
  • 13 Khurana S, Kane AE, Brown SE, Tarver T, Dusing SC. Effect of neonatal therapy on the motor, cognitive, and behavioral development of infants born preterm: a systematic review. Dev Med Child Neurol 2020; 62 (06) 684-692
    Google Scholar
  • 14 Pineda R, Guth R, Herring A, Reynolds L, Oberle S, Smith J. Enhancing sensory experiences for very preterm infants in the NICU: an integrative review. J Perinatol 2017; 37 (04) 323-332
    Google Scholar
  • 15 Giachetta L, Nicolau CM, Juliani RCTP, de Carvalho WB, Krebs VLJ. Characterization of the motor performance of newborns in a neonatal unit of tertiary level. Rev Assoc Med Bras (1992) 2016; 62 (06) 553-560
    Google Scholar
  • 16 Harding C, Cockerill H, Cane C, Law J. Using non-nutritive sucking to support feeding development for premature infants: a commentary on approaches and current practice. J Pediatr Rehabil Med 2018; 11 (03) 147-152
    Google Scholar
  • 17 Barbosa VM. Teamwork in the neonatal intensive care unit. Phys Occup Ther Pediatr 2013; 33 (01) 5-26
    Google Scholar
  • 18 Pineda R, Bender J, Hall B, Shabosky L, Annecca A, Smith J. Parent participation in the neonatal intensive care unit: Predictors and relationships to neurobehavior and developmental outcomes. Early Hum Dev 2018; 117: 32-38
    Google Scholar
  • 19 Craciunoiu O, Holsti L. A systematic review of the predictive validity of neurobehavioral assessments during the preterm period. Phys Occup Ther Pediatr 2017; 37 (03) 292-307
    Google Scholar
  • 20 Griffiths N, Spence K, Loughran-Fowlds A, Westrup B. Individualised developmental care for babies and parents in the NICU: evidence-based best practice guideline recommendations. Early Hum Dev 2019; 139: 104840
    Google Scholar
  • 21 Pineda R, Wallendorf M, Smith J. A pilot study demonstrating the impact of the supporting and enhancing NICU sensory experiences (SENSE) program on the mother and infant. Early Hum Dev 2020; 144: 105000
    Google Scholar
  • 22 Treyvaud K, Spittle A, Anderson PJ, O'Brien K. A multilayered approach is needed in the NICU to support parents after the preterm birth of their infant. Early Hum Dev 2019; 139: 104838
    Google Scholar
  • 23 Robison LD. An organizational guide for an effective developmental program in the NICU. J Obstet Gynecol Neonatal Nurs 2003; 32 (03) 379-386
    Google Scholar
  • 24 Ross K, Heiny E, Conner S, Spener P, Pineda R. Occupational therapy, physical therapy and speech-language pathology in the neonatal intensive care unit: patterns of therapy usage in a level IV NICU. Res Dev Disabil 2017; 64: 108-117
    Google Scholar
  • 25 Sigurdson K, Mitchell B, Liu J. et al. Racial/ethnic disparities in neonatal intensive care: a systematic review. Pediatrics 2019; 144 (02) e20183114
    Google Scholar
  • 26 American Academy of Pediatrics: NICU Search. Accessed November 11, 2021 at: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/nicuverification/Pages/NICUSearch.aspx
    Google Scholar
  • 27 NICU Directory. Accessed November 11, 2021 at: https://neonatologysolutions.com/nicu-directory/
    Google Scholar
  • 28 VON Member Map and Member List. Accessed November 11, 2021 at: https://public.vtoxford.org/member-map/
    Google Scholar
  • 29 CHNC Participants. Accessed November 11, 2021 at: https://thechnc.org/home-page/participants/
    Google Scholar
  • 30 World Population Review. 2021 ; Accessed November 11, 2021 at: https://worldpopulationreview.com
    Google Scholar
  • 31 American community survey. Accessed November 11, 2021 at: https://www.census.gov/acs/www/data/data-tables-and-tools/data-profiles/
    Google Scholar
  • 32 Harvison N. Academic programs annual data report: Academic year 2017–2018. 2019 ; Accessed November 11, 2021 from. https://www.aota.org/-/media/Corporate/Files/EducationCareers/Educators/2017-2018-Annual-Data-Report.pdf
    Google Scholar
  • 33 Mitchell K, Ellison J, Gleeson P. Current practices and perceptions of admission criteria at physical therapist education programs in the United States. J Phys Ther Educ 2019; 33 (01) 55-63
    Google Scholar
  • 34 Sylvan L. et al. Building blocks of knowledge: a close look at prerequisite coursework for graduate programs in speech-language pathology. Perspect ASHA Spec Interest Groups 2020; 5: 1262-1271
    Google Scholar
  • 35 Harrison W, Goodman D. Epidemiologic trends in neonatal intensive care, 2007-2012. JAMA Pediatr 2015; 169 (09) 855-862
    Google Scholar
  • 36 Spencer CS, Gaskin DJ, Roberts ET. The quality of care delivered to patients within the same hospital varies by insurance type. Health Aff (Millwood) 2013; 32 (10) 1731-1739
    Google Scholar
  • 37 DeFranco EA, Lian M, Muglia LA, Schootman M. Area-level poverty and preterm birth risk: a population-based multilevel analysis. BMC Public Health 2008; 8: 316
    Google Scholar
  • 38 Braveman PA, Heck K, Egerter S. et al. The role of socioeconomic factors in Black-White disparities in preterm birth. Am J Public Health 2015; 105 (04) 694-702
    Google Scholar
  • 39 Colvin JD, Hall M, Berry JG. et al. Financial loss for inpatient care of medicaid-insured children. JAMA Pediatr 2016; 170 (11) 1055-1062
    Google Scholar
  • 40 McManus BM, Richardson Z, Schenkman M. et al. Child characteristics and early intervention referral and receipt of services: a retrospective cohort study. BMC Pediatr 2020; 20 (01) 84
    Google Scholar
  • 41 Little AA, Kamholz K, Corwin BK, Barrero-Castillero A, Wang CJ. Understanding Barriers to Early Intervention Services for Preterm Infants: Lessons From Two States. Acad Pediatr 2015; 15 (04) 430-438
    Google Scholar
  • 42 Dunn S. Interprofessional shared decision making in NICU: a mixed methods study. Accessed November 11, 2021 at: https://ruor.uottawa.ca/bitstream/10393/19903/1/Dunn_Sandra_2011_thesis.pdf
    Google Scholar
  • 43 Stein J, Visco CJ, Barbuto S. Rehabilitation medicine response to the COVID-19 pandemic. Am J Phys Med Rehabil 2020; 99 (07) 573-579
    Google Scholar
  • 44 Scala M, Marchman VA, Brignoni-Pérez E, Morales MC, Travis KE. Impact of the COVID-19 pandemic on developmental care practices for infants born preterm. medRxiv [Preprint] 2020 Nov 30:2020.11.25.20238956. Update in: Early Hum Dev. 2021 Dec;163
    Google Scholar
  • 45 Kroelinger CD, Okoroh EM, Goodman DA, Lasswell SM, Barfield WD. Comparison of state risk-appropriate neonatal care policies with the 2012 AAP policy statement. J Perinatol 2018; 38 (04) 411-420
    Google Scholar
  • 46 Stark AR. American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal care. Pediatrics 2004; 114 (05) 1341-1347
    Google Scholar
  • 47 Welch CD, Check J, O'Shea TM. Improving care collaboration for NICU patients to decrease length of stay and readmission rate. BMJ Open Qual 2017; 6 (02) e000130
    Google Scholar