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"A baby might be in the NICU from four weeks to four to six months," Stuckly said. "They're usually scared and afraid to make a bond, thinking 'What if something happens?' "

Stuckly said her application of Touchpoints tools made an immediate difference for some of these parents. Stuckly showed parents how their underdeveloped premature babies still respond to parents' voices. She advised them to look for visual clues, like the ones she picked up from her experiences with her own baby born earlier this year.

"I've noticed my baby likes it better to be bathed in the evening, so I'll tell them to look for specific behaviors [like that]," Stuckly said. "But we let [the parents] guide themselves."

Power to the parents

Parental empowerment is the most important lesson most nurses feel they learn from Touchpoints training. Michelle Lansford, RN, a neonatal nurse educator at Cook Children's in Fort Worth, noticed the dramatic improvement in parents of sick children maintaining critical follow-up visits through Touchpoints education.

"Many times, our children are going to have a lifelong battle with health issues," Lansford said. "So if we can build a good relationship with the family as their real first step into the health care realm, maybe they'll be more trusting and be able to build relationships along the way, instead of avoiding it and having that 'doctor fear' and that 'nurse fear.' "

The improvement of parental involvement in child care was evidenced in a study in Napa County. Kristie Brandt, ND, MSN, CNM, chief of public health for the Napa County Health and Human Services, said patients with Touchpoints-trained providers have one-fourth more well-child visits and follow-ups, while emergency room and sick-child visits to health care facilities were drastically cut in half. "That was phenomenal," Brandt said.

Smith said Harris Methodist will conduct surveys to contrast pre- and post-training attitudes of participating nurses, and introduce Touchpoints-related questions and comments to employee evaluation forms. Ultimately, the hospital would like to incorporate Touchpoints checklists into daily reports filled out by nurses, Smith said.

For Los, the Napa PHN, she didn't need the results of a study to see what Touchpoints does for her revolving caseload of 50 clients-a majority of whom have a distrust of social service agents such as Los. Instead of anger and apathy, many of the troubled parents opened up to her through the Touchpoints discussions. They kept appointments, followed through with meetings and promises, and in some cases sought her out for questions and advice about their children, Los said.

The 16-year-old girl in the teen home, who, at one point, had no inkling of her motherly instinct, became one of Los' most successful cases. She kept her regular visits with Los throughout the following year, and even returned to finish school to fight for a better future for herself and her baby.

"It was powerful," Los said. "By building [their] trust with you and building a relationship, you can all work together."

Contact Glen Fest at glenf@nurseweek.com