A NICU admission is inherently stressful and difficult for many families to bear. Often, a NICU admission is completely unexpected. The separation of mother and child, along with a baby’s critical health care needs, can be traumatic. Social workers are uniquely equipped to serve the needs of both the medical team and the family. The role of the social worker in the NICU is to strengthen and empower families, encourage family resilience, and promote positive developmental outcomes for babies through assessment, advocacy, and support.

In our NICU, social workers see any family with an identified social risk factor and all babies born at or below 32 weeks gestation or any gestational age with a critical or chronic health need. When social workers meet with families, they assess the family’s social environment and mental health, the family’s strengths and needs, and any potential risks that may be present for the baby. Social workers also provide a brief orientation to the NICU and anticipatory guidance around what to expect throughout the NICU admission. Social workers educate caregivers about postpartum depression, coping with having a baby in the NICU, and adjustment to a child’s chronic illness. Throughout a baby’s NICU stay, social workers continually work with families to assess for postpartum depression, develop coping strategies, and assist with bonding with the new baby.

If a situation arises which presents a risk to the baby, social workers will sometimes contact child protective services to ensure a safe discharge plan for the baby.  Child protective services has the ability to assess the caregivers in their home environment and provide intervention beyond the scope of the hospital. Involving child protective services does not always mean that a baby will not be discharged with their caregivers, but rather serves as a bridge to provide additional supportive and protective services to the families.

Social workers also act as advocates for families during a baby’s NICU stay, both within and outside the NICU. In the hospital, we can advocate for families by acting as a bridge between the family and the medical team. Social workers facilitate family meetings, help families articulate the questions that they have to the team, and help identify and correct communication breakdown between the provider and the family. Social workers also act as advocates by ensuring that a family has access to all community resources that may be beneficial for the family or the baby. Social workers can assist with public aid applications, home visiting and parenting support program referrals, and Early Intervention referrals upon discharge. Social workers also advocate for safe discharges for babies by advocating for families to receive appropriate teaching and support prior to discharge. Throughout the wider hospital, social workers advocate for cross-culturally informed and trauma-sensitive practices, polices, and procedures.

Throughout a baby’s NICU stay, social workers provide support to the family. Sometimes, this means providing supportive counseling, anticipatory guidance, or reminding a family of their strengths. Other times, this means validating and normalizing a family’s feelings, providing a safe space for a family to vent, or helping a family to process their NICU experience. We can also help moms understand and identify symptoms of postpartum depression in themselves, and can connect moms to counseling resources when necessary. Social workers also provide grief support during a loss or a baby’s sudden clinical decompensation. Often, social workers provide crisis intervention to support families in situations of extreme stress or family conflict.  Social workers can also help to coordinate an interdisciplinary team response to a family’s crisis to ensure that each team member’s strengths and expertise are best utilized.

Social workers work closely with the interdisciplinary team, including nurses, to provide support to families throughout the patient’s hospitalization. Social workers depend on report and documentation from nurses about the daily care that a family is able to provide from their child, and what teaching or additional resources that a family can benefit from. Social workers also use nurses’ observations, assessments, and expertise to help identify which families may benefit the most from the social work intervention. Nurses can identify the need for a social worker when they notice a family having difficulty coping or difficulty learning a baby’s complex care needs who may benefit from additional resources. Nurses can also provide great insight into a family’s normal visitation schedule, preferred communication style, and coping with a patient’s NICU admission. Social workers consider nurses’ observation and insight when completing assessments and planning interventions.

As a social worker, I strive to meet families where they are at. In the NICU, families can experience a range of emotions—feeling thrilled that their new baby is here, being terrified about their baby’s medical status, being anxious and uncomfortable in the ICU environment, being angry at the loss of a hoped-for birth experience, being confused by medical lingo and NICU procedures, and being excited to take their baby home.  No matter what a family is going through, I hope to be an empowering and helpful presence as I support them with my clinical skills and knowledge.

Ali Bullington, LSW, MSW

Ali Bullington, LSW, MSW, is a social worker in the NICU at Comer Children’s Hospital in Chicago, Illinois.

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