{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:09:07Z","timestamp":1785409747497,"version":"3.56.0"},"reference-count":37,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wechsler Jacques Family Integrated Behavioral Health Fund"},{"name":"Health Resources and Services Administration Graduate Psychology Education Program"},{"id":[{"id":"https:\/\/ror.org\/0121dpf30","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000071","name":"NIH","doi-asserted-by":"publisher","award":["T32 HD098066\/HD\/NICHD NIH HHS\/United States"],"award-info":[{"award-number":["T32 HD098066\/HD\/NICHD NIH HHS\/United States"]}],"id":[{"id":"10.13039\/100000071","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Therapeutic playgroups have shown promise in enhancing caregiver\u2013infant mental health outcomes, yet tailored approaches for families following neonatal intensive care unit (NICU) admission remain limited. In this brief report on Quality Improvement, we evaluate key strategies and challenges in implementing an adapted therapeutic playgroup intervention designed for caregivers and infants with a history of NICU hospitalization at University of California, San Francisco and Zuckerberg San Francisco (UCSF) Zuckerberg San Francisco General Hospital (ZSFG) We conducted semi-structured interviews with NICU psychologists to assess local feasibility, barriers, and facilitators to implementation. Implementation science frameworks\u2014the Consolidated Framework for Implementation Research (CFIR) and Proctor et al.\u2019s implementation outcomes framework (acceptability, adoption, appropriateness, feasibility, and sustainability)\u2014were used to guide data organization and interpretation. Qualitative reporting guidelines were followed to enhance transparency in describing interviews and analytic procedures. The psychologists emphasized the importance of embedding therapeutic playgroups within existing clinical workflows, providing flexible delivery models, and customizing curricula to meet cultural and family-specific needs. Multidisciplinary collaboration enhanced feasibility and parent engagement. Barriers included organizational constraints and variability in caregiver readiness. These findings inform local program development and highlight considerations for integrating dyadic mental health support into post-NICU care. Future work should incorporate caregiver perspectives and explore effective interventions across diverse settings.<\/jats:p>","DOI":"10.3390\/bs16040600","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T16:30:36Z","timestamp":1776443436000},"page":"600","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementing Outpatient Therapeutic Playgroups for NICU Families: A Quality Improvement Project"],"prefix":"10.3390","volume":"16","author":[{"given":"Mariana C.","family":"Aokalani","sequence":"first","affiliation":[{"name":"Children\u2019s National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine L.","family":"Wisner","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA"},{"name":"School of Medicine and Health Sciences, George Washington University, Ross Hall, 2300 Eye Street, NW, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6812-7898","authenticated-orcid":false,"given":"Nickie N.","family":"Andescavage","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA"},{"name":"School of Medicine and Health Sciences, George Washington University, Ross Hall, 2300 Eye Street, NW, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1735-0069","authenticated-orcid":false,"given":"Catherine","family":"Limperopoulos","sequence":"additional","affiliation":[{"name":"Children\u2019s National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA"},{"name":"School of Medicine and Health Sciences, George Washington University, Ross Hall, 2300 Eye Street, NW, Washington, DC 20037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara K.","family":"Stuart","sequence":"additional","affiliation":[{"name":"Zuckerberg San Francisco General Hospital & Trauma Center, 1001 Potrero Avenue, Building 5, 6B, San Francisco, CA 94110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"ref_1","first-page":"24","article-title":"WePlay! Across the USA and abroad: Adaptation and expansion of a postpartum caregiver\u2013child support program","volume":"11","author":"Antenucci","year":"2024","journal-title":"International Journal of Birth and Parent Education"},{"key":"ref_2","unstructured":"Aokalani, M. C. (2024). I see you! Play: A therapeutic playgroup for caregivers and their intensive care group infants. [Doctoral thesis, Graduate School of Professional Psychology]. Available online: https:\/\/digitalcommons.du.edu\/capstone_masters\/514."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Baraldi, E., Allodi, M. W., Smedler, A. C., Westrup, B., L\u00f6wing, K., and \u00c5d\u00e9n, U. (2020). Parents\u2019 experiences of the first year at home with an infant born extremely preterm with and without post-discharge intervention: Ambivalence, loneliness, and relationship impact. International Journal of Environmental Research and Public Health, 17, (24).","DOI":"10.3390\/ijerph17249326"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2016","DOI":"10.1037\/dev0000557","article-title":"Family nurture intervention for preterm infants facilitates positive mother-infant face-to-face engagement at 4 months","volume":"54","author":"Beebe","year":"2018","journal-title":"Developmental Psychology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1037\/int0000113","article-title":"Interpersonal psychotherapy for PTSD: Treating trauma without exposure","volume":"29","author":"Bleiberg","year":"2019","journal-title":"Journal of Psychotherapy Integration"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12978-025-02033-x","article-title":"Born too soon: Global epidemiology of preterm birth and drivers for change","volume":"22","author":"Bradley","year":"2025","journal-title":"Reproductive Health"},{"key":"ref_7","first-page":"57","article-title":"Prematurity, attachment, and interpersonal therapy: A review","volume":"37","author":"Cerqueira","year":"2023","journal-title":"Journal of Prenatal and Perinatal Psychology and Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/1748-5908-4-50","article-title":"Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science","volume":"4","author":"Damschroder","year":"2009","journal-title":"Implementation Science"},{"key":"ref_9","first-page":"28","article-title":"Interpersonal psychotherapy for groups: Advantages and challenges","volume":"21","author":"Deans","year":"2014","journal-title":"Psychotherapy in Australia"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"DiBari, J. N., and Rouse, L. (2023). Parent perspectives: Part 2-considerations for the transition home post-NICU discharge. Children, 10, (12).","DOI":"10.3390\/children10121835"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e090155","DOI":"10.1136\/bmjopen-2024-090155","article-title":"Transition to home after very preterm birth: Improving outcomes of children and their families-a systematic review protocol","volume":"14","author":"Engel","year":"2024","journal-title":"BMJ Open"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Ettenberger, M., Maya, R., Salgado-Vasco, A., Mosalve-Duarte, S., Betancourt-Zapata, W., Suarez-Ca\u00f1on, N., Prieto-Garces, S., Mar\u00edn-S\u00e1nchez, J., G\u00f3mez-Ortega, V., and Valderrama, M. (2021). The effect of music therapy on perceived pain, mental health, vital signs, and medication usage of burn patients hospitalized in the intensive care unit: A randomized controlled feasibility study protocol. Frontier Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.714209"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.yhbeh.2015.10.001","article-title":"The neurobiology of mammalian parenting and the biosocial context of human caregiving","volume":"77","author":"Feldman","year":"2016","journal-title":"Hormones and Behavior"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.tics.2016.11.007","article-title":"The neurobiology of human attachments","volume":"21","author":"Feldman","year":"2017","journal-title":"Trends in Cognitive Sciences"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.invent.2016.05.004","article-title":"Supporting parents of premature infants transitioning from the NICU to home: A pilot randomized control trial of a smartphone application","volume":"4","author":"Garfield","year":"2016","journal-title":"Internet Interventions"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/jmt\/thaa023","article-title":"Longitudinal study of music therapy\u2019s effectiveness for premature infants and their caregivers (LongSTEP): Feasibility study with a norwegian cohort","volume":"58","author":"Ghetti","year":"2021","journal-title":"Journal Music Therapy"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1542\/peds.34.1.58","article-title":"Reactions to the threatened loss of a child: A vulnerable child syndrome","volume":"34","author":"Green","year":"1964","journal-title":"Pediatrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e135","DOI":"10.1016\/j.pedn.2022.08.014","article-title":"Scoping review of interventions to support families with preterm infants post-NICU discharge","volume":"67","author":"Griffith","year":"2022","journal-title":"Journal of Pediatric Nursing"},{"key":"ref_19","first-page":"8","article-title":"WePlay denver: Introducing a flexible, caregiver-led parent-child group","volume":"29","author":"Gross","year":"2021","journal-title":"Perspectives in Infant Mental Health Journal"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.pedhc.2019.07.005","article-title":"Utilization of NICU infant medical indices to classify parental risk for stress and family burden","volume":"34","author":"Grunberg","year":"2020","journal-title":"Journal of Pediatric Health Care"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gund, A., Sj\u00f6qvist, B. A., Wigert, H., Hentz, E., Lindecrantz, K., and Bry, K. (2013). A randomized controlled study about the use of eHealth in the home health care of premature infants. BMC Medical Informatics and Decision Making, 13.","DOI":"10.1186\/1472-6947-13-22"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1002\/imhj.22086","article-title":"Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent-infant interactions and maternal sensitivity","volume":"44","author":"Hartzell","year":"2023","journal-title":"Infant Mental Health Journal"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/1357633X20913411","article-title":"Comparison of video and in-hospital consultations during early in-home care for premature infants and their families: A randomised trial","volume":"28","author":"Dessau","year":"2022","journal-title":"Journal of Telemedicine and Telecare"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"105283","DOI":"10.1016\/j.earlhumdev.2020.105283","article-title":"Vulnerable child syndrome in the neonatal intensive care unit: A review and a new preventative intervention with feasibility and parental satisfaction data","volume":"154","author":"Hoge","year":"2021","journal-title":"Early Human Development"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1038\/s41372-021-01256-7","article-title":"Protecting the infant-parent relationship: Special emphasis on perinatal mood and anxiety disorder screening and treatment in neonatal intensive care unit parents","volume":"42","author":"Paulsen","year":"2022","journal-title":"Journal of Perinatology"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Martin, J. A., and Osterman, M. J. K. (2025). Increases in neonatal intensive care admissions in the United States, 2016\u20132023 (NCHS Data Brief No. 525).","DOI":"10.15620\/cdc\/174581"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e2020029397","DOI":"10.1542\/peds.2020-029397","article-title":"Home visiting for NICU graduates: Impacts of following baby back home","volume":"148","author":"McKelvey","year":"2021","journal-title":"Pediatrics"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e1414","DOI":"10.1542\/peds.2005-2580","article-title":"Reducing premature infants\u2019 length of stay and improving parents\u2019 mental health outcomes with the creating opportunities for parent empowerment (COPE) neonatal intensive care unit program: A randomized, controlled trial","volume":"118","author":"Melnyk","year":"2006","journal-title":"Pediatrics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e20161870","DOI":"10.1542\/peds.2016-1870","article-title":"NICU-based interventions to reduce maternal depressive and anxiety symptoms: A meta-analysis","volume":"139","author":"Mendelson","year":"2017","journal-title":"Pediatrics"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1111\/jan.13879","article-title":"Randomized controlled trial on effectiveness of mHealth (mobile\/smartphone) based Preterm Home Care Program on developmental outcomes of preterms: Study protocol","volume":"75","author":"Nayak","year":"2019","journal-title":"Journal of Advanced Nursing"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1007\/s10488-010-0319-7","article-title":"Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda","volume":"38","author":"Proctor","year":"2011","journal-title":"Administration and Policy in Mental Health and Mental Health Services Research"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.infbeh.2011.09.006","article-title":"Effects of early mother\u2013infant intervention on outcomes in mothers and moderately and late preterm infants at age 1 year: A randomized controlled trial","volume":"35","author":"Ravn","year":"2012","journal-title":"Infant Behavior and Development"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Shaw, R. J., Givrad, S., Poe, C., Loi, E. C., Hoge, M. K., and Scala, M. (2023). Neurodevelopmental, mental health, and parenting issues in preterm infants. Children, 10, (9).","DOI":"10.3390\/children10091565"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1097\/ANC.0000000000000835","article-title":"Transition from the neonatal intensive care unit to home: A concept analysis","volume":"21","author":"Shillington","year":"2021","journal-title":"Advances in Neonatal Care"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1542\/peds.2012-0426","article-title":"Long-term benefits of home-based preventive care for preterm infants: A randomized trial","volume":"130","author":"Spittle","year":"2012","journal-title":"Pediatrics"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Swenson, S. A., Desai, R. K., Velagala, S., Hoge, M. K., Htun, Z., Carr, C. B., Roush, K., Liu, C. H., Maddox, K., and Erdei, C. (2025). From NICU to home: Meeting the mental health needs of families after discharge. Journal of Perinatology: Official Journal of the California Perinatal Association, Advance online publication.","DOI":"10.1038\/s41372-025-02503-x"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"International Journal for Quality in Health Care"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/4\/600\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T10:29:52Z","timestamp":1777458592000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/4\/600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,17]]},"references-count":37,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["bs16040600"],"URL":"https:\/\/doi.org\/10.3390\/bs16040600","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,17]]}}}