Date of Award

2026

Document Type

Scholarly Project

Degree Name

Doctor of Occupational Therapy (OTD)

Department

Occupational Therapy

First Advisor

Dr. Anne Haskins

Abstract

Background and Purpose: One out of ten infants born in the United States are admitted to the Neonatal Intensive Care Unit (NICU); a status that has been directly linked to ongoing infant health disparities and disabilities, requiring continued support and education following discharge (Griffith et al., 2022; National Center for Health Statistics, 2025). NICU graduates and their families work with occupational therapy to address or prevent developmental delays and ensure well-being (Craig, 2018; Riley & de Sam Lazaro 2021).

Methodology: A literature review was conducted to determine the needs of the population and context and include NICU admissions, family needs, occupational therapy services, current evidence-based practice, developmental milestones, and health disparities. This scholarly project was developed while onsite at a rural outpatient pediatric practice setting that allowed for informed building of the final product containing resources for clinicians and education for parents. The scholarly project was developed using the assumptions of the Person-Environment-Occupation Model (PEO) (Law et al., 1996). For inclusive use of Occupational Therapy for the NICU Graduate: A Guide to Developmental Follow-Up, all parent handouts were created using evidence on adult literacy rates, all material for caregivers/parents were created at or below a sixth-grade level (Bastable et al., 2020). For further inclusive use of Occupational Therapy for the NICU Graduate: A Guide to Developmental Follow-Up translation to Spanish of the viii Educational Handouts was completed with collaboration with the University of North Dakota Spanish department to ensure accuracy. Multiple continuing education opportunities were completed to further inform the development of the product including Healthy Children Project, Inc. Center for Breastfeeding Lactation Counselor Training Course, Dr. Browns Medical with the course, Neurodevelopmental Perspectives on Nipple Flow Rates: Optimizing Safe Feeding Strategies, and review of publications on developmental milestones from the Center for Disease Control (Academy of Lactation Policy and Practice, 2022; Dr. Brown’s Medical, 2025; Zubler et al., 2022).

Outcomes: Occupational Therapy for the NICU Graduate: A Guide to Developmental Follow-Up was developed to provide occupational therapy clinicians to provide care for NICU graduates (and their families) and comprised of two parts: Guide for Practitioners and Educational Handouts. The Guide for Practitioners contains in-depth information about the educational handouts, potential assessments to use for evaluation, and goals to be used in documentation. The Education Handouts portion contains fifteen handouts in 9 different categories including, chronological versus adjusted age, one-to-eighteen-month developmental milestones and play activities, infant cues, breast feeding support, bottle nipple flow, national mental health resources, local mental health resources, transitioning to solid foods, and infant sleep. The education handouts are provided in both English and Spanish to enhance its usability within numerous populations.

Conclusion: This scholarly project was created to address the occupational therapy evaluation and interventions for NICU graduates at an outpatient pediatric therapy clinic, increase occupational performance of the child and caregivers, and provide resources for practitioners to provide best practice care for this population. The long-term goal of this project is to provide evidenced based care through the lens of occupational therapy to the NICU graduate population at a rural outpatient therapy clinic.

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