The Use of the Emotional Availability Scales in Neonatal Intensive Care Units: A Feasibility Study

Purpose/Hypothesis: The Emotional Availability Scale (EAS) is a well-established instrument measuring affective qualities of parent-child relationships. Adult dimensions of the EAS include Sensitivity, Structuring, Non-Intrusiveness, and Non-Hostility. Child dimensions include Responsiveness and Involvement. Despite preterm birth impacting parent mental health, infant development, and parent-infant relationships, the EAS has not been used to quantify parent-preterm infant relationships in the neonatal intensive care unit (NICU). We aimed to determine the feasibility and inter- and intra-rater reliability of the EAS when administered within a NICU setting.

Number of Subjects: Subjects were nine infants with a mean gestational age of 27.1 weeks (SD=4.3) at birth and their parents.

Materials/Methods: Parent-infant dyads were retrospectively assessed at two timepoints. The first timepoint was between 36-40 weeks gestation, as soon as the infant was stable (defined as off of ventilator support, independent with thermoregulation, and cleared by the medical team). The second timepoint took place three weeks later. The EAS was scored using 5-minute videos of parent-infant interactions, collected as part of a larger study. Scoring was deemed feasible if a composite, direct score was attained on the four parent scales and one of the two infant scales of the EAS. Percent agreements were calculated by dividing the number of codes within +/- one point by the total number of codes. Percent agreement between a primary and secondary coder was determined by scoring 15% of the videos for intra-rater reliability after a one-week waiting period and 40% of the videos for inter-rater reliability without discussion with a minimum threshold set at > 85% agreement.

Results: All 18 videos of parent-infant interactions in the NICU were feasibly scored. Intra-rater agreement for the primary and secondary coders were both 100%. Inter-rater agreement was 99.04%.

Conclusions: We have identified the EAS as a feasible and reliable instrument for quantifying the affective qualities of parent-infant relationships at a critical time for both infant development and for the establishment of parent-infant relationships.

Clinical Relevance: The EAS is an instrument that may provide NICU and early intervention physical therapists with a measure of the security and health of parent-infant relationships. We hope to next explore the potential of parent-infant relationship qualities to impact a parent’s ability to sensitively deliver recommended physical therapy interventions and an infant’s potential to benefit from the intervention.