# Training and Integration of Eat, Sleep, Console Model for Infants and Families at an Urban Academic Health Center

## TL;DR

This paper describes the training and implementation of the Eat, Sleep, Console (ESC) model for managing neonatal opioid withdrawal syndrome in an urban academic health center.

## Contribution

The study introduces a multidisciplinary training program for ESC, emphasizing nonpharmacologic care and parent-infant relationships.

## Key findings

- Training improved self-rated preparedness to use nonpharmacologic interventions for NOWS.
- Multidisciplinary education supported successful ESC implementation in clinical settings.
- Pre- and posttraining surveys showed statistically significant improvements in clinician preparedness.

## Abstract

Eat, Sleep, Console (ESC) is an effective approach for evaluating and managing neonatal opioid withdrawal syndrome (NOWS). The current standard, Finnegan Neonatal Abstinence Scoring System, requires waking neonates to assess NOWS and prioritizes pharmacotherapy treatment. However, ESC focuses on infants’ abilities to function and cope with opioid withdrawal, prioritizes nonpharmacologic interventions, and emphasizes the crucial role of the parent–infant relationship. We created and delivered ESC training for perinatal and neonatal staff and clinicians across an urban academic health center.

We utilized the knowledge-to-action framework to guide project design and implementation. The training program consisted of 30- to 60-minute didactic sessions for neonatal and perinatal clinicians and staff on labor and delivery and neonatal intensive care units, an ESC algorithm for care, and pre- and posttraining surveys.

We trained 254 participants (nurses, OB/GYN, and family medicine attending physicians and residents, neonatal advanced practice clinicians, midwives, social workers) through virtual educational sessions. Eighty-eight participants completed pre- or posttraining surveys, and 11 completed both surveys. Posttraining results demonstrated statistically significant improvement in self-rated preparedness to use nonpharmacologic interventions (mean score 3.91 vs. 4.64, pre- vs. posttraining paired surveys on 5-point scale [1 = strongly disagree, 5 = strongly agree]; p = .03;). Pre/posttraining unpaired survey results indicated high levels of preparedness implementing ESC concepts.

ESC education enhanced preparedness of birthing staff and clinicians to implement the nonpharmacologic ESC tool for management of NOWS. Coordinated, multidisciplinary education and collaboration support the successful implementation of ESC in clinical settings.