Research evidence

There have been clinical studies quantitatively and qualitatively evaluating the effects of the Close Collaboration with Parents training. We also introduce some ongoing studies.

Summary of the training and its evidence

Ahlqvist-Björkroth S, Axelin A, Lehtonen L. Close Collaboration with Parents-Implementation and effectiveness. Acta Paediatr. 2024.
https://doi.org/10.1111/apa.17210

This article summarizes the content of the training and evidence to date.

 The training improves family-centered care culture in NICUs

Four clinical studies compared NICUs in Finland or Estonia before and after the implementation of the training.

Itoshima R, Toome L, Varendi H, Saik P, Axelin A, Lehtonen L, Ahlqvist-Björkroth S. Outcomes following Close Collaboration with Parents Intervention in Neonatal Intensive Care Units. JAMA Open Netw. In press.
https://doi.org/ 10.1001/jamanetworkopen.2024.54099

  • This comparison study was carried out in 6 NICUs in Estonia that had implemented the training.
  • Family-centered care culture in the NICUs was evaluated using 9 questions. We found significant improvements in the total rating of family-centered care by both the parents of newborn infants admitted to the NICUs and all NICU health care staff.
  • The items which improved after the implementation were active listening, individual guidance and emotional support rated by the parents; and participation in care, individual guidance, shared decision-making, mutual trust between parents and staff, individual information, emotional support and participation in medical rounds rated by the health care staff.
  • We also evaluated the implementation fidelity using the completion rate of the staff training, which ranged from 13.3% to 82.2% among the NICUs.
  • The high implementation fidelity was associated with better improvement in the family-centered care ratings.

Toivonen M, Lehtonen L, Ahlqvist-Björkroth S, Axelin A. Effects of the Close Collaboration With Parents Intervention on the Quality of Family-Centered Care in NICUs. Adv Neonatal Care. 2023;23(3):281-289.
https://doi.org/10.1097/anc.0000000000000953

  • This comparison study was carried out in 5 NICUs in Finland that had implemented the training.
  • Family-centered care culture in the NICUs was evaluated using 8 or 9 questions. The total rating by the fathers and nurses improved after the implementation. The ratings by the mothers did not change significantly as they were at a high level already before the training. The items which improved after the training were shared decision-making rated by fathers and  active listening, parents’ trust in staff, and emotional support for parents rated by nurses.

Toivonen M, Lehtonen L, Löyttyniemi E, Ahlqvist-Björkroth S, Axelin A. Close Collaboration with Parents intervention improves family-centered care in different neonatal unit contexts: a pre-post study. Pediatr Res. 2020;88(3):421-428
https://doi.org/10.1038/s41390-020-0934-2

  • This comparison study was carried out in 8 NICUs in Finland that had implemented the training.
  • The quality of family-centered care was evaluated by both the NICU staff and the parents using the Bliss Baby Charter audit tool. The quality improved in all NICUs after the implementation of the training.
  • The study also included interviews with about 50 nurses and 30 parents before and after the implementation, respectively. The interviews gave examples of the changes that had happened in the care culture including the following: parents participated in the baby care more regardless of the severity of the baby’s condition after the implementation. The NICU nurses better supported the family’s discharge preparation and provided more individualized care for the baby based on his/her behaviors after the implementation.

Axelin A, Ahlqvist-Björkroth S, Kauppila W, Boukydis Z, Lehtonen L. Nurses' perspectives on the close collaboration with parents training program in the NICU. MCN Am J Matern Child Nurs. 2014;39(4):260-8.
https://doi.org/10.1097/nmc.0000000000000061

  • Interviews with 22 nurses were analyzed in the NICU, which implemented the training first.
  • Nurses rexperienced  beneficial changes after the training. Their role had changed from a caregiver to a facilitator who helps the parents care for their babies.
  • The changes in the role of the staff promoted parents’ participation in the care of their babies and enabled the staff to understand the parents’ psychosocial condition.

The training extends the duration of parents’ presence and parent-infant skin-to-skin contact in NICUs.

He FB, Axelin A, Ahlqvist-Björkroth S, Raiskila S, Löyttyniemi E, Lehtonen L. Effectiveness of the Close Collaboration with Parents intervention on parent-infant closeness in NICU. BMC Pediatr. 2021;21(1):28.
https://doi.org/10.1186/s12887-020-02474-2

  • This clinical study in 9 NICUs in Finland that had implemented the training studied  infants admitted to the NICUs and their parents.
  • The duration of both the mothers’ and fathers’ presence in the NICU extended significantly after the implementation.
  • The duration of mother-infant or parent-infant skin-to-skin contact also extended significantly after the implementation.

The training improves the postpartum depressive symptoms of mothers of preterm infants.

Ahlqvist-Björkroth S, Axelin A, Korja R, Lehtonen L. An educational intervention for NICU staff decreased maternal postpartum depression. Pediatr Res. 2019;85(7):982-986.
https://doi.org/10.1038/s41390-019-0306-y

  • A clinical study of mothers of preterm infants born weighing 1500 g or less was carried out in the NICU that implemented the training first in Finland.
  • The mothers’ postpartum depressive symptoms were evaluated at 4-6 months of corrected age using the Edinburgh Postnatal Depression Scale (EPDS). Lower EPDS scores  after the implementation indicated less postpartum depressive symptoms among mothers.

Ahlqvist-Björkroth S, Axelin A, Setänen S, Huhtala M, Korja R, Pape B, Lehtonen L. Fewer maternal depression symptoms after the Close Collaboration with Parents intervention: Two-year follow-up. Acta Paediatr. 2022;111(6):1160-1166.
https://doi.org/10.1111/apa.16303

  • A clinical study of mothers of preterm infants born weighing 1500 g or less was carried out in the NICU that implemented the training first in Finland.
  • The EPDS score at 2 years of corrected age decreased significantly after the implementation.

The training promotes growth and decreases the length of stay of preterm infants.

Itoshima R, Helenius K, Ahlqvist-Björkroth S, Vahlberg T, Lehtonen L. Close Collaboration with Parents Affects the Length of Stay and Growth in Preterm Infants: A Register-Based Study in Finland. Neonatology. 2024;121(3):351-358.
https://doi.org/10.1159/000535517

  • This register study in Finland included all preterm infants born < 35 weeks of gestation in any of all (23) NICUs in Finland between 2006 and 2020.
  • The implementation of the training significantly decreased the length of stay in the NICUs by 1.8 days (6%) and increased the growth in weight by 11.7 g/week and in length by 1.3 mm/week. In addition, the odds of having at least one unscheduled outpatient visit between discharged home and one year of age decreased significantly after the implementation (adjusted odds ratio 0.81).

Ongoing studies

Intervention study evaluating the parents’ discharge preparation in a NICU in Japan

Activities in Japan

Activities in Japan

March 2025Yuki Fukao, RN, Toshie Okabe, RN, Makiko Noda, RN, and Ryo Itoshima, MD, wrote articles about family-centered care in Nagano Children's Hospital and the Close Collaboration with Parents training for with NEO, a magazine published by MEDICUS SHUPPAN,Publishers Co., Ltd.
November 2024Asahi Broadcasting Nagano presented family-centered care and the implementation of the Close Collaboration with Parents training in Nagano Children’s Hospital through their TV program and YouTube channel.
https://www.youtube.com/watch?v=uAnwD-FNxcU
November 2024Ryo Itoshima, Sari Ahlqvist-Björkroth, and Sanna Pick made a lecture at Tokyo Metropolitan Government Building titled “Close Collaboration with Parents training −an educational program to change the mindset of health care staff regarding family-centered care”
November 2024The 68th national meeting of Japan Society for Neonatal Health and Development was organized in Matsumoto, Nagano, under the theme “Future of family centered care.”
Arata Oda, MD, Ryo Itoshima, MD, Toshie Okabe, RN, Makiko Noda, MW, and Yuko Tanaka, RN participated in the lectures, symposiums, and workshops. We also had guests from Finland, Liisa Lehtonen, Sari Ahlqvist-Björkroth, Sanna Pick, and Siw Hellsten.
July 2024The second Crosstalk Meeting on Family Centered Care was held in Osaka by Medica Shuppan.
Arata Oda, MD, Ryo Itoshima, MD, Kanae Hatta, RN, Sayuri Aruga, RN gave lectures.
March 2024Arata Oda, MD contributed to the following journal article and mentioned family-centered care and the Close Collaboration with Parents training
Oda A. ファミリーセンタードケアとは何か. The journal of the Japan Pediatric Society 2024;128(3):443-452.
February 2024Arata Oda, MD made the following educational presentation at the first research meeting of Japan Children’s Palliative Care Network (JCPCN) in Osaka
“Family-centered care in NICU”
November 2023The healthcare staff implementation of the Close Collaboration with Parents training started at Nagano Children’s Hospital NICU.
October 2023The first Crosstalk Meeting on Family Centered Care was held in Tokyo by Medica Shuppan.
Arata Oda, MD, Ryo Itoshima, MD, and Makiko Noda, MW gave lectures. We also had guests from Finland, Liisa Lehtonen, Sari Ahlqvist-Björkroth, Sanna Pick, and Siw Hellsten, who made lectures.
July 2023The first Crosstalk Webinar on Family Centered Care was held by Medica Shuppan.
Arata Oda, MD and Ryo Itoshima, MD gave lectures.
May 2023Nagano Children’s Hospital NICU started the implementation of the Close Collaboration with Parents training.
2023-2024Ryo Itoshima, MD wrote the nine series of articles about family-centered care and the Close Collaboration with Parents training, published by MEDICUS SHUPPAN,Publishers Co., Ltd.
August 2022The first Japan-Finland Neonatal Joint Seminar was held in Turku, Finland. Family centered care and the Close Collaboration with Parents were the major topics of the seminar. Ryo Itoshima, MD, was among the organizing team of the seminar.
Takehiko Hiroma, MD, Arata Oda, MD, Ryo Ogawa, MD, Yumiko Momose, RN, Toshie Okabe, RN, Makiko Noda, MW, and Satsuki Sakurai, RN participated from Japan.
2020 onwardRyo Itoshima, MD, has been staying in Turku to study at the University of Turku, Finland as a researcher and a PhD student.
July 2019The 55th Annual Congress of Japan Society of Perinatal and Neonatal Medicine was held in Matsumoto, Nagano.
Liisa Lehtonen came from Finland and gave a lecture about family centered care and the Close Collaboration with Parents training.

Funding

  • 2024 Scandinavia-Japan Sasakawa Foundation
    “Understanding of the Couplet Care of neonatal intensive care by visiting two hospitals in Finland and Sweden”
    0.4M JPY
  • 2024 Japan Society for the Promotion of Science, Grants-in-Aid for Scientific Research
    “Assessing the medical sociological benefits of family centered care in neonatal intensive care units”
    3.6M JPY
  • 2022 Japan Society for the Promotion of Science, Bilateral Collaborations
    “Can family-centered neonatal care save hospital costs and improve later outcomes?”
    2.5M JPY
  • 2020 Grant for Clinical and Medical Research from Nagano Children’s Hospital
    “Evaluating the current status and the effects of family centered care in the neonatal intensive care unit”
    0.3M JPY