Frequently Asked Questions
What is the Newborn Individualized Developmental Care
and Assessment Program (NIDCAP)?
Newborn Individualized Developmental Care and Assessment Program (NIDCAP),
developed by Heidelise Als, PhD and her colleagues, is a comprehensive approach
to care that is developmentally supportive and individualized to the infant's
goals and level of stability. Further it seeks to support families and the
professionals who care for them. It provides and trains professionals within
this NIDCAP framework.
One component of the model of care is the direct observation of the infants
within their environments in the newborn intensive care setting. Using a
detailed observational tool, often referred to as the NIDCAP observation, the
infant's behaviors can be interpreted as steady and relaxed or as representing
stress or discomfort. By observing and then interpreting behaviors of infants
within their environment and as reactions to care they receive, developmental
care plans can be developed, with the caregiving team, that best support's the
infant's overall goals and efforts at self regulation.
The NIDCAP model, which includes this observation, describes the development of
an ever-more supportive and developmentally appropriate nursery environment
(from the actual physical space to the delivery of care), and interrelated, the
increasing nurturance of the family and the staff, and the continued education
and mutual collaboration of the staff (from the direct caregivers through the
administrative leadership).
The NIDCAP approach to care requires in-depth training and provides in turn a
highly valuable resource in support of developmental support and care provision
by professionals and families.
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Who may be assessed with the NIDCAP?
Preterm and fullterm newborns in the newborn intensive care setting are
appropriate for NIDCAP assessment. Infants are typically observed in their
bedspaces within the nursery before, during, and after caregiving experiences.
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For whom is NIDCAP training appropriate?
- Persons eligible for NIDCAP Training are professionals, who are associated with
or on staff of a Newborn Intensive Care and/or Special Care Nursery, are
approved for training by the applicant nursery, and are supported in their
training to become active facilitators of the implementation of individualized
developmentally supportive and family centered care in the respective setting.
NIDCAP training is appropriate for clinicians and developmental professionals
and consultants in the newborn intensive care, healthy newborn nursery, and
follow-up clinic setting. This includes psychologists, neonatologists,
neurologists, psychiatrists, developmental pediatricians, advanced degree nurse
clinicians, physical, occupational, and speech/language therapists as well as
infant or developmental specialists.
- NIDCAP training is a requirement for all those providing formal NIDCAP training
(certified NIDCAP Trainers).
- NIDCAP training is highly recommended for all developmental specialists and
developmental nurse educators in charge of the implementation and facilitation
of developmental care in newborn intensive and special care nurseries as well as
in healthy newborn nurseries.
- NIDCAP training is a requirement for all those, who wish to use the NIDCAP as a
research instrument.
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What are the prerequisites prior to beginning
NIDCAP training?
Trainees must be staff members in hospital nursery settings with newborns
infants.
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What is involved in training?
Prior to training, the trainee is expected to read and study the required
articles from the reading list. Additionally, trainees must complete Site and
Self Assessment questionnaires with the support and guidance of the nursery
leadership and their colleagues. Professionals with little nursery experience
must apprentice themselves to nurses and/or neonatologists to gain educational
and experiential training in their understandings of newborns and nursery
settings.
The first formal training typically consists of a three-day introductory session
at the trainee's hospital. On the first day, the NIDCAP trainer gives an
introductory lecture describing the theoretical model and applications of the
NIDCAP approach and provides a workshop of the observational tool. On the second
day, with a maximum of two trainees, an observation is performed with a
corresponding write-up. And on the third day, the NIDCAP trainer provides
consultation to the nursery team, guides the trainees through their homework,
develops a timeline for training, and meets with the administrative leadership
supporting the integration of the NIDCAP model of care.
Trainees practice NIDCAP observations and writing NIDCAP reports at their own
hospital. To appreciate the 24-hour experiences of infants in the nursery,
trainees are recommended to observe 3 different infants (high intensive care,
intermediate, close to discharge) in four to six hour timeframes. Also, 20
observations of infants before, during and following caregiving are required
(five infants from intensive care, intermediate care, and pre-discharge, and
five from the healthy fullterm nursery).
During the training process, trainees may send write-ups to their NIDCAP trainer
for review of their work. After integrating suggestions made by the trainer,
trainees schedule a "NIDCAP work session" with the trainer. NIDCAP work sessions
consist typically of two to three day-sessions scheduled at the trainee's site,
consultation to the developmental team and the beginning of the next training
step, the Advanced Practicum (the weekly observations of a very low birth weight
infant from birth to discharge, with write-ups and support to the family and
nursery caregivers).
NIDCAP reliability consists of the accurate articulation of the observed infant's
behaviors, including strengths and fragilities, developmental summary and
recommendations for care. Certification is achieved with this evaluation of the
observation and the completed Advanced Practicum with thorough understandings of
the infant and support to the caregiving team (including the family).
See the Program Guide for a
complete description of the training process.
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How long does the training process take?
From the outset training, the site leadership team is encouraged to develop a
strategic five-year plan for the increasingly cohesive adoption of a
developmentally supportive nursery with the NIDCAP model of care.
The average training process for individual trainees from the introductory
lecture and bedside training day to certification typically requires 12 months,
depending on the practice time availability of the trainee.
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Where are the NIDCAP training centers located?
There are currently sixteen NIDCAP Training centers (10 in the U.S., 5 in Europe
and 1 in South America). See the Training
Centers page of the NFI website.
Contact individual centers with questions and to discuss training opportunities
and fee structures for training costs.
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What is the Assessment of Preterm Infants'
Behavior (APIB)?
The Assessment of Preterm Infants' Behavior (APIB) is a comprehensive
and systematic neurobehavioral assessment of preterm and fullterm newborns
developed by Heidelise Als, PhD and her colleagues.
Als, H., Lester, B.M., Tronick, E., & Brazelton, T.B. (1982).
Towards a systematic assessment of preterm infants' behavioral development. In
H.E. Fitzgerald, B.M. Lester, and M.W. Yogman (Eds.), Theory and Research in
Behavioral Pediatrics (pp. 35-63). New York: Plenum Press.
Als, H., Lester, B.M., Tronick, E., & Brazelton, T.B. (1982). Manual for the
assessment of preterm infants' behavior (APIB). In H.E. Fitzgerald, B.M. Lester,
and M.W. Yogman (Eds., Theory and Research in Behavioral Pediatrics (pp.
65-132). New York: Plenum Press.
The APIB, based on the Brazelton Newborn Behavioral Assessment Scale (NBAS,
Brazelton, T. Berry, 1973. Philadelphia: JB Lippincott Co.), provides further
refinement of the identification of infants' self regulatory efforts and
thresholds to disorganization as viewed through aspects of the infant's
behaviors referred to as subsystem interactions.
The subsystems of the infant are formally observed and considered in terms of
their organization and include: autonomic, motor, state, attention, and
self-regulation. Additionally, the degree of examiner facilitation necessary in
order to support the infant's reorganization when disorganized is also assessed.
The exam proceeds through a series of maneuvers that increase in vigor as well
as tactile and vestibular demand. Further, the assessment examines the integrity
of the infant's sleep organization, systematically elicited movement repertoire,
and availability and quality of social interaction. The stability and
organization of the infant's subsystems are continuously evaluated in their
mutual interplay with each other, and in turn in their interplay with the
examination's graded demands.
The APIB requires in depth training and provides in turn a highly valuable
resource in support of developmental support and care provision by professionals
and families.
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Who may be assessed with the APIB?
Preterm and fullterm newborns
Preterm infants, who may be brought into an examining room (e.g., parent room)
and handled, typically 32 weeks post menstrual age and older, are appropriate
for examination. Individualized, knowledgeable judgment is required to determine
the appropriateness of an APIB assessment at very early ages and/or levels of
great sensitivity or significant illness. Infants, who are still too fragile or
ill, may better be assessed with Newborn Individualized Developmental Care and
Assessment Program (NIDCAP) observations and/or the beginnings of the APIB
examination at their bedsides, without movement to a special examination room.
Well developing fullterm infants may be productively assessed with the APIB to
approximately 44 weeks post menstrual age. For preterm infants and high risk
full term infants the evaluation may still be appropriate for several weeks
beyond that. Pairing the APIB with the Bayley Scales of Infant Development,
Third Edition is a useful option at these later ages.
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For whom is APIB training appropriate?
- APIB training is appropriate for clinicians and developmental professionals and
consultants in the newborn intensive care, healthy newborn nursery, and
follow-up clinic setting. This includes psychologists, neonatologists,
neurologists, psychiatrists, developmental pediatricians, advanced degree nurse
clinicians and physical, occupational, and speech/language therapists and well
as infant or developmental specialists. Training and experience in formal
standardized testing is a prerequisite.
- APIB training is a requirement for all those providing formal NIDCAP training
(certified NIDCAP Trainers).
- APIB training is highly recommended for all developmental specialists and
developmental nurse educators in charge of the implementation and facilitation
of developmental care in newborn intensive and special care nurseries as well as
in healthy newborn nurseries.
- APIB training is a requirement for all those, who wish to use the APIB as a
research instrument.
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What are the prerequisites prior to beginning
APIB training?
It is strongly recommended that trainees be certified in BNBAS and/or the Newborn
Individualized Developmental Care and Assessment Program (NIDCAP).
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What is involved in training?
Prior to training, the trainee is expected to read and study the required
articles from the reading list and observe APIB assessments from a certified
examiner (when possible).
The first formal training typically consists of a two-day introductory session at
the trainee's hospital. Special considerations may be made for trainees to
schedule APIB introductory training sessions at the West Coast Training Center.
Two, and in exceptional circumstances maximally three, trainees may participate
in this introduction. Trainees observe the trainer examine an infant each
morning and then spend the remainder of each day discussing administration and
scoring details for the assessment. A timeframe and plan for working towards
certification is addressed.
Trainees practice administering and scoring APIB assessments at their own
hospitals, first with healthy fullterms, then with increasingly younger preterm
infants, while they continue to assess healthy fullterm infants as well in order
to stay aware at all times of the continuum of newborn behavior. The number of
examinations and the timing of initiating examinations with preterm infants are
dependent on the training, experience, background, and skill of the respective
trainee.
After approximately 10 to 15 evaluations, an "APIB work session" is scheduled
with the trainer. APIB work sessions consist typically of two to three
day-sessions scheduled at the trainee's site. They are structured so that each
trainee has his or her own day to perform the APIB assessment, with ideally one
or two fellow trainees observing. The respective trainees independently score
the jointly observed evaluation. The APIB trainer gives feedback regarding
administration as well as scoring in a joint session with all two or three
trainees present together. On the subsequent one or two days each of the other
trainees examines an infant, while the others observe. All trainees score all
assessments. Typically, two and at times three work sessions are necessary
before trainees achieve administrative and scoring reliability on the APIB
assessment.
APIB reliability is again a two or three-day session in analogy to the work
sessions described. Reliability consists in appropriate administration and
accurate scoring of the APIB demonstrated with two different infants.
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How long does the training process take?
The training process from demonstration and introductory training to
certification typically requires one to two years, depending on the practice
time availability of the trainee.
Initially each APIB administration and scoring requires a full eight-hour day.
Eventually the administration typically requires an hour, and for a skilled
examiner scoring should be achieved in under an hour.
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Where are the APIB training centers
located?
There are currently two APIB Training centers in the U.S. They are the National
NIDCAP Training Center in Boston, Children's Hospital Boston, Boston,
Massachusetts with APIB trainer Heidelise Als, PhD, and the West Coast NIDCAP &
APIB Training Center at University of California San Francisco School of
Medicine, San Francisco, California with APIB trainer Deborah Buehler, PhD.
Contact information is as follows:
Boston: Sandra Kosta
sandra.kosta@childrens.harvard.edu
San Francisco: Kathleen A. VandenBerg, PhD,
vandenbergk@peds.ucsf.edu
Fee structures for training costs are available from the respective training
center.
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