1. Home Support for the Premature Infant WATCH Preemie presentation

2. Objectives: Identify resources that therapists can access to provide great preemie care. Understand 3 subtle issues to watch for as therapists provide services, especially in the early months, with preemies

3. Agenda HHIP program description/changes Impact of changes on other agencies Transition to home/early treatment Therapist techniques Child issues/concerns Motor issues Later/other issues Other programs/resources

4. Hospital–Home Intervention Program WakeMed HHIP Hospital–Home Intervention Program Beth Cooper Ann Marie Elmore Jim Helm Cindy Redd Funded by Wake County SmartStart, an organization that ensures children are prepared for success in school and life.

5. Hospital–Home Intervention Program WakeMed HHIP Hospital–Home Intervention Program Changing model 3 year grant funding cycle IT-P high risk eligibility criteria changed

6. Eligibility Past < 32 weeks <1500 grams (3lbs 5oz) & Vent > 6 hr Current < 27 weeks or < 1000 grams (2lbs 3.5 oz)

7. Impact on other CDSA contract agencies Will be treating preemies earlier Will need to address self-regulation as a 1° concern that impacts other areas of daily care

8. Most Common Challenges Reported by Parents Sleeping Feeding Self-Regulation Social Interactions

9. Impact on other CDSA contract agencies Parent consultation vs. hands on therapy Parents may need weekly support vs. children may need monthly developmental monitoring. Transitional issues include lots of Q/A on parenting

10. When ready to do hands on recognize and respond to behavioral cues for avoidance vs. approach support regulatory efforts to help baby succeed

11. Ready or not? Not – Avoidance!

12. Ready - Approach

13. Ready – Supported for Success!

14. Motor Issues Monitor – Prevent Extensor Dominance Limited Rotation Head Preference/ Plagiocephaly Encourage - Facilitate Flexion Trunk/Pelvic Mobility Weight Shifting Varied Positions

15. Extensor Dominance Flexion Trunk/Pelvic Mobility

16. Limited Rotation

17. Head Preference/ Plagiocephaly

18. Later/Other Issues issues with older children and regulation monitor other potential concerns

19. Outcome of VLBW & ELBW without major mental or motor impairments Poor attention/ Hyperactivity Lower IQs Behavioral / Social Skills Difficulty Visual Perceptual / Visual Motor Problems Problems with Executive Function Msall & Park 2008

20. Other programs/resources Family Support Network SICC Beyond the NICU workshop Transition Visits Children that get discharged from I-TP Parents As Teachers Child Service Coordination Program