Synapse Spotlight: Angelica Moreyra talks family mental health in the NICU

Welcome to another installment of Synapse Spotlight where we feature an interview with an inspiring NICU healthcare professional.

Today we interviewed Dr. Angelica Moreyra, Psy.D., a NICU Psychologist from Children’s Hospital Los Angeles/USC, about her research and programs to support family mental health in the NICU.

 Tell us a little bit more about you and your background and what inspired you to work in the NICU.

I am a psychologist who went into Grad School for clinical psychology, and as you can imagine, the NICU was not even on my radar. 

I first started out as an outpatient trauma psychologist, really focusing primarily on children and families and trauma.

Through training opportunities in a pediatric nursing facility, I began incorporating a more medical trauma lens, working with families who have experienced a traumatic injury or a more chronic illnesses. I really enjoyed the relationship between the psychology and medical aspects, that mind body relationship. I became interested in working in more acute settings because I felt like there was so much value to having a psychological presence on the interdisciplinary team.  

This eventually led to my postdoctoral work in the Stanford NICU Fellowship, where I found a unique opportunity to create a program working with mothers and babies. It  was the perfect intersection of my trauma background working with children and families and then, as it has happened for many before me, I fell in love with the NICU.

 

 

Can you tell us more about your work in the Stanford NICU Fellowship?

I really enjoyed the opportunity to be a part of an interdisciplinary team  working towards a common goal of caring for this family, caring for the baby, and wanting to provide more of a mental health presence. So many other areas in hospital settings have supports for mental health, however, in the NICU there has historically been a lack of a  mental health presence. This felt exciting to me, but also intimidating, because we needed to create a new program to be able to work with this special population.

As a part of my fellowship, working with Dr. Richard Shaw, we drew on his earlier work with mothers of premature infants in the NICU. In 2013, through an NIH funded grant, Dr. Shaw published the results of his study identifying and helping mothers cope with depression, anxiety, and post traumatic stress symptoms. The individual intervention were wildly efficacious, however the program fell flat because after the research funding ended, they didn’t have anybody with time dedicated to the NICU. They didn’t have a mental health provider who could roll out this intervention on an ongoing basis. 

So my role was to come into the NICU and start providing that individual intervention that uses components trauma focused of cognitive behavioral therapy, as well as cognitive processing therapy, while also adapting it to a group model to help combat the general feeling of disconnection and isolation that so many NICU parents feel. The group model we developed for mothers of preterm infants was really focused on reducing and preventing symptoms of depression, anxiety, and trauma. 

We wanted to test the effectiveness of the group intervention model in comparison to the individual intervention and therefore created a study that will compare group outcomes to historical outcomes and data collected from the individual intervention study (published in 2013). During my fellowship we submitted an IRB to collect data from mother’s who participate in group intervention including outcome measures collected at baseline, six weeks, and six months and ran pilot groups to be gain feedback from mother’s related to their experience in the group. Overall, the group intervention was positively received and mother’s described the intervention as being helpful and important. One mother noted that “this group should be mandatory for all moms, just liking washing your hands is mandatory for coming into the NICU.” 

 

 

Do you have any plans or are there any plans to update or expand the program in the future? 

Yes, we are continuing to collect data from over 100 mothers and are in the process of analyzing that data to identify trends in symptoms of anxiety, depression, and trauma that we have captured through developing standardized screenings in the NICU. We rolled out standardized screenings at the two week mark following admission to mother and fathers of infants in the NICU. So stay tuned because we are definitely working on putting together an article publishing our results. 

One of the more exciting things about this screening is that the way in which the NICU social workers embraced our tool. I think the fear that often comes up with screening for mental distress is, what if someone’s screens positive? Then how do we address that?

I think the feedback that I got from social workers that I’ve worked with has been that it’s been really helpful in identifying families that are really struggling, but who present themselves as doing really well. We have found families that really seem to have it all together; they are present for rounds, they come to all team conferences, they’re present at the bedside, holding and engaging appropriately with their baby and most of us would not think this family would necessarily warrant a referral to further mental health services. However, when we were getting the screening forms back on these seemingly low risk families, they were in fact experiencing really high levels of depression, anxiety and trauma symptoms. I think this was really a huge eye opener for the entire team.  We realized that just using our own clinical judgment of how someone’s presenting on the unit, might not actually be reflective of what’s happening on the inside.

Also, Dr. Shaw and I are continuing to work together to create a consultation program to be able to take our intervention and provide training for other social workers or other mental health professionals in NICU settings. 

 

What would you say is the most rewarding part of what you do?

The most rewarding part of what I do, I think is that families allow me to join with them during the hardest time in their life, during the time where they’re feeling most overwhelmed, most stressed, most hopeless. That a family is allowing me to join in alongside them for that journey is such a privilege and honor that I do not take lightly. 

Working in the NICU there are ongoing crisis every single day for the families. Every day there is some kind a new crisis to be overcome; a new obstacle to work through. 

Families hear new information that can either be really uplifting or really disappointing. And being able to work with families throughout all of this up and down roller coaster that comes along with being in the NICU is very rewarding. There are times that there aren’t good outcomes, and there are times when you get to see them go home and being able to be a part of the good, the bad and the ugly is such a privilege for me.

What advice would you give new nurses, social workers, therapists that are just starting their career in the NICU about supporting mental health in families?

I think my advice for those just starting in the NICU would be to remember that as NICU professionals, we are choosing to come into the NICU as a part of our job choice, whereas the families are being forced into this situation.

The NICU experience is not something most parents have planned for, and I think sometimes losing sight of that creates a situation where we express less empathy. It can be hard for the team sometimes to understand why a family isn’t more present at bedside or why a family is being so difficult, and micromanaging our routine care. If we step back and remember that the NICU is not an environment that they actually want to come into, or feel any sort of confidence or autonomy in, then we can really be more effective when interacting with the more challenging families. 

 What is one thing that you do every day to keep you sane in the midst of the chaos of the NICU?

I have developed a few routines that I use during the time in between leaving the hospital for the day and arriving home. I will typically call a family member or a friend to hear what’s going on in their life to kind of pull me back into reality – that the NICU is not my world. Hearing from other people about how their jobs are going or you know, just basic life updates definitely helps me create distance from my work. 

I find that I crave lightness after work because the NICU can be very heavy in a lot of different ways. I often times listen to comedy playlists on Spotify. Even if we’ve had a day with celebrations for a certain patient, it can still feel heavy. So being able to kind of go home with this kind of more lightheartedness and listening to comedy I think really helps me leave work at work. 

 

Dr. Angelica Moreyra is a clinical psychologist dedicated to working with, serving, and supporting families. She has experience working with children and families who have experienced various forms of trauma in several different settings including community mental health programs, partial hospitalization programs, and most recently inpatient medical units (NICU, PICU). Currently, Dr. Moreyra specializes in working with perinatal mental health, infancy, and attachment and bonding issues of families that are currently or have been in the NICU. Dr. Moreyra’s passion for creating a supportive, warm, and caring therapeutic environment allows for patients facing the most challenging experiences in their lives to feel as if they have their own team member guiding them through the difficult process of having an infant with medical complications.

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