Profiles

Erika Baraldi

Erika Baraldi

Doktorand, projektkoordinator

Visa sidan på svenska
Telephone 08-120 764 62
Email erika.baraldi@specped.su.se
Visiting address Frescati hagväg 10
Room 228
Postal address Specialpedagogiska institutionen 106 91 Stockholm

About me

Licensed Psychologist and PhD student at Stockholm University.

My research subject is within the multi-professional field of intervention programs for Extreme Preterm children in interaction with their caregivers. The aim of the intervention is to promote the executive functions of the child and in the long-term perspective provide the Extreme Preterm child with optimal conditions for learning and health when growing up. My principal supervisor is professor Mara Westling Allodi from the department of Special Education Stockholm University and assistant supervisor is professor Ann-Charlotte Smedler from the department of Psychology Stockholm University. My PhD research project would not be possible to launch without the multiprofessional research team, including medical doctor and professor of neonatology Ulrika Ådén, child physiotherapist and PhD Kristina Löwing, medical doctor and PhD Björn Westrup, all  three from Karolinska Institutet department of children and women health.

I have worked as a clinical Psychologist since 2008 within various fields, such as forensic psychotherapy, organizational psychology and currently at the child- and adolescent psychiatry in Stockholm. My main interests are developmental issues of small children and multi-professional solutions and challenges where psychiatry interacts with somatic conditions.

See links to my work and publications in the Swedish version of this page.

Teaching

Have worked as a superviser for psychologist students during their fifth semester when they work as councellors in upper secondary schools of Stockholm, 2015-2019.

Hosting a workshop in playfulness and treatment for children and families at the child and adolescence psychiatry, targeting psychologist students at Stockholm university (since 2018 and ongoing). 

Have been teaching medical doctor students at Karolinksa Institutet at their voluntary courses Perinatology (January 2019), infant mental health as a part of  child- and adolescence psychiatry (2019 and ongoing) and speech and language therapist-students (2020 and ongoing).  

Research

Licensed psychologist and PhD student in Special Education in a multidisciplinary research project focused on early intervention of extremely preterm borm children and their parents. The project is a cooperation between Stockholm University, Karolinska Institute and the four intensie neonatal care units in Stockholm. Principal supervisor is Professor Mara Westling Allodi and assistant supervisor is Professor Emerita Ann-Charlotte Smedler.

Extremely preterm born children often spend over three months at the neonatal clinic before they come home for the first time. The hospital ward is full of knowledgable professionals constantly advising, supporting and interacting with the parents, but once home the situation drastically changes for most families and there is a lack of support in this process of transition. To reduce stress and increase the positive interactions between parents and children, our study will offer home-visits for the forst year of the child's life. The aim of the study is to improve the long-term outcome of the child, parental mental health and the positive baby-parental interaction.  

Inclusion for SPIBI September 2018 - Septmeber 2020. 

Funding:

The SPIBI-research has been funded by

  • Stockholm University faculty funds funded the PhD position 50% 2016-2024.
  • Stockholm County Council through the collaboration program with Stockholm University 2017-2019 (SU-SLL no. 20160881) funded the interventionist training, the interventionist work and the cooperation between the universities
  • Centrum för kompetensutveckling inom vård och omsorg at Stockholm University (CKVO) 2018-19 funded the coordination and some of the supervision of the project. (no. SU FV 2.1.1 - 402417). 
  •  Clas Groschinskys Minnesfond 2018 funded the motor and psychological supervision. (no. SF 18 109). 
  • Queen Silvia Jubilee Fund for research on children and disability (date of letter of acceptance 13th of December 2017) funded the writing of the Swedish manual.
  • Filénska fonden 2017/2018, funded the education and material for Emotional Availability Scales. 
  • K & A Wallenberg foundation funded a research trip to an early intervention conference in Sydney in 2019 (no. SU FV 2..1.9.1894-18)
  • Lilla barnets fond (The Fund For Small Children) funded the ongoing research project in 2019.
  • Erika Baraldi was awarded the Nils W Svenningsen stipendiet in 2019. 

Presentations:

The SPIBI-project was presented at the International Society on Early Intervention ISEI Conference in June 2019 in Sydney, Australia. Title: "The development of a post-discharge intervention program in Sweden for extremely preterm infants and their caregivers, through home visits during their first year of life". Authors; 

Erika Baraldi¹, Ulrika Ådén², Kristina Löwing², Ann-Charlotte Smedler¹, Björn Westrup² & Mara Westling Allodi¹

¹Stockholm University, ²Karolinska Institutet

The SPIBI-project was presentet at the jENS conference in Maastricht in Spetember 2019. Title: "Clinical protocol abnd research process of Stockholm Preterm Interaction-Based Intervention, SPIBI". Authors: 

Erika Baraldi¹,Mara Westling Allodi¹, Kristina Löwing², Ann-Charlotte Smedler¹, Björn Westrup² & Ulrika Ådén²

¹Stockholm University, ²Karolinska Institutet

Publications

A selection from Stockholm University publication database
  • 2020. Erika Baraldi (et al.). BMC Pediatrics 20 (1)

    Background: Improved neonatal care has resulted in increased survival rates among infants born after only 22 gestational weeks, but extremely preterm children still have an increased risk of neurodevelopmental delays, learning disabilities and reduced cognitive capacity, particularly executive function deficits. Parent-child interaction and parental mental health are associated with infant development, regardless of preterm birth. There is a need for further early interventions directed towards extremely preterm (EPT) children as well as their parents. The purpose of this paper is to describe the Stockholm Preterm Interaction-Based Intervention (SPIBI), the arrangements of the SPIBI trial and the chosen outcome measurements.

    Methods: The SPIBI is a randomized clinical trial that includes EPT infants and their parents upon discharge from four neonatal units in Stockholm, Sweden. Inclusion criteria are EPT infants soon to be discharged from a neonatal intensive care unit (NICU), with parents speaking Swedish or English. Both groups receive three initial visits at the neonatal unit before discharge during the recruitment process, with a strengths-based and development-supportive approach. The intervention group receives ten home visits and two telephone calls during the first year from a trained interventionist from a multi-professional team. The SPIBI intervention is a strengths-based early intervention programme focusing on parental sensitivity to infant cues, enhancing positive parent-child interaction, improving self-regulating skills and supporting the infant’s next small developmental step through a scaffolding process and parent-infant co-regulation. The control group receives standard follow-up and care plus extended assessment. The outcomes of interest are parent-child interaction, child development, parental mental health and preschool teacher evaluation of child participation, with assessments at 3, 12, 24 and 36 months corrected age (CA). The primary outcome is emotional availability at 12 months CA.

    Discussion: If the SPIBI shows positive results, it could be considered for clinical implementation for child-support, ethical and health-economic purposes. Regardless of the outcome, the trial will provide valuable information about extremely preterm children and their parents during infancy and toddlerhood after regional hospital care in Sweden.

    Trial registration: The study was registered in ClinicalTrials.gov in October 2018 (NCT03714633).

  • Erika Baraldi (et al.).

    Background

    Extremely preterm (EPT) born children are at increased risk of cognitive and neurodevelopmental impairment, neuropsychiatric disorders and academic difficulties. Parents of EPT born children are extra vulnerable for anxiety, posttraumatic stress disorder and depression and the parent-child interaction is negatively affected by prematurity. There is some evidence that early interventions have beneficial effects on neurocognitive and motor outcomes (Spittle A et al 2015). Based on a previous intervention (Verkerk G et al 2012) and adjusted to the Swedish context with 480 days paid parental leave, we created a post–discharge intervention, SPIBI, for families of EPT born children.

    Method

    The aim of (SPIBI) is to improve the quality of the parent-child interaction, child development and parental mental health in families with EPT born children. . SPIBI is a randomized controlled beginning at discharge and lasting until the child is 12 months corrected age. The trial design is a two arm randomized trial with four recruiting sites in Stockholm. Intervention group (target, n=65) receives 10 visits and two telephone calls from a trained interventionist and the control group (target n=65) receives treatment as usual plus an extended follow-up program. The SPIBI-team has recruited and trained 6 multi-professional and NICU-experienced interventionists. The training takes one year (0.2 of full time) and the content was both theoretical and practical, including pilot-cases. 

    Result

    SPIBI is an ongoing research project, beginning the 1st of September 2018 and planning to end recruitment the 31st of August 2020 and finishing the home-visits in August 2021. By the end of April 2019, 33 eligible infants had been identified within the four neonatal units in Stockholm; of which 26 children approved and 7 children declined participation. At this stage, three children have dropped out of the study, because of severe social challenges and child death. Identified challenges have been social and medical vulnerability of the EPT-families, finding the optimal multi-professional balance of motoric, psychological, pedagogical and medical kernels of the intervention, ethical considerations when to ask families for participation, lack of long-term discharge-planning of the neonatal units and large geographical spread of NICUs as well as families.

    Conclusion

    In conclusion, the protocol seem to be feasible and appreciated by parents in the target group. With regard to the small recruitment base, trials of this kind needs a long inclusion time. Since EPT-children and their parents displays a wide scope of difficulties and challenges, multi-professional cooperation is preferable, placing high demands of sensitivity, professional respect and time for long collaborative processes.

  • 2019. Erika Baraldi (et al.).

    Sweden has a proactive neonatal intensive care, saving children born from gestation week 22, with a 90% survival rate in the extremely preterm (EPT) group. With increased survival rates, the long-term outcome of the EPT children has gained much research interest. Recent studies indicate that 1/3 of the EPT-children in Sweden show moderate to severe neurodevelopmental deficits when beginning school. An interdisciplinary research team has designed an intervention for EPT infants and their caregivers in their home-environment after hospital discharge and throughout the first year of life. The aim of the ongoing randomized controlled trial is to study intervention effects on the children’s cognitive, motor and psychosocial function, the parental mental health and the infant-parent interaction. This paper present the intervention’s theory of change, the validity considerations, and an overview of the syllabus of the training given to the interdisciplinary team of six clinicians who serve as interventionists. 

  • 2020. Erika Baraldi (et al.).

    In Sweden 400 children yearly are born extremely preterm (EPT; more than three months early). These children have an increased risk of later academic difficulties, neuropsychiatric disorder, cognitive and mental health issues. Since the first 1000 days of the brain development are so crucial for later development, the interdisciplinary Stockholm Preterm Interaction-Based Intervention (SPIBI) aims at strengthening the parent-child interaction, child development and parental mental health. 

    The research is based on pedagogical, motor-developmental, medical and psychological science. The program is based on Vygotski’s theory of the zone of proximal development, as well theoretical frameworks of early intervention (Guralnick; Shonkoff). Additionally, Als’ synactive theory of understanding premature infant communication and needs, Bowlby’s attachment theory, and Emde’s emotional availability theory have been applied. 

    SPIBI is an ongoing research project funded by Stockholm-County-Stockholm-University joint-collaboration grant 20160881. It is an RCT targeting 130 EPT infants and their parents in Stockholm with a 3-year inclusion period starting September 2018. The intervention consists of ten home-visits during the first year by trained interventionists, supporting the next developmental step of the child through a scaffolding process, strengthening parental sensitivity to infant cues, and promoting infant’s self-regulation. SPIBI has recruited and trained six multi-professional-NICU-experienced interventionists. Control group participants receive TAU plus an extended follow-up program.

    The overall aim is to present the framework and theory of change of SPIBI, relating to research findings, welfare policies and recommendations for infant’s “chain of care”. So far, sixty eligible infants have been identified within four neonatal units; of which 48 approved participation. The primary outcome is emotional availability of the parent and child, where we hypothesize that the intervention will affect the parental sensitivity and structure of interaction with the child. Secondary outcomes concern child development, i.e. motor development, cognition and occurrence of neuropsychiatric symptoms, parental mental health, anxiety and self-efficacy, where we also hypothesize positive effects of the intervention. 

    • Since Nordic countries have neonatal intensive care of high quality, the amount of EPT survivors is high compared to other countries; therefore, the educational systems must follow achievements reached by health care system and develop new evidence-based interventions in early childhood education, which are appropriated for EPT born children and their parents, following recent European Standards of Care for Newborn Health (2018).
    • Insights from neuro-cognition, early intervention and educational research has shown the importance of interdisciplinary interventions, and this should be spread around the Nordic countries.
    • Nordic countries offer a unique social environment, with governmental funded parental-leave, enabling early-interventions delivered by parents.
    • The EPT children in Nordic countries are less affected by socioeconomic factors, as is often the case where maternity welfare and obstetrics is not publically financed. Hence, Nordic countries have a unique opportunity to perform research targeting EPT students and their parents specifically, with less confounding factors.
    • Some Nordic countries have adopted policies concerning home-visiting support and infants’ rights, as recommended by the World Association of Mental health’s policy statement from 2016, and Nordic knowledge exchange and collaboration on these policies is warranted. 
  • 2018. Erika Baraldi.
  • 2019. Erika Baraldi.
  • 2019. Erika Baraldi (et al.).

    Bakgrund

    I Sverige föds mellan 300 och 400 barn innan den 28 graviditetsveckan. Omkring 2/3 av de extremt prematurfödda barnen har ingen eller en mild funktionsnedsättning medan 1/3 har medelsvår till svår funktionsnedsättning vid skolstart (Serenius et al, 2016). De vanligaste svårigheterna efter extrem prematur födsel är intellektuell funktionsnedsättning (Jarjour, 2015), i synnerhet svårigheter med arbetsminnet och den exekutiva funktionsutvecklingen (Stålnacke et al., 2018;  Mulder et al., 2009). Även neuropsykiatriska funktionsnedsättningar som ADHD (Burnett et al., 2014) och autism är överrepresenterade i gruppen prematurfödda barn, 8- 29% av de extremt prematurfödda barnen skattas positivs på screeningtest för AST (Johnson et al., 2010; Kim, 2016 & Padilla et al., 2015).

    Inte bara barnet påverkas av den extremt för tidiga födseln, även föräldrarna kastas snabbt in i ett stressigt föräldraskap till ett skört och ofta sjukt spädbarn som inte är som de föreställde sig under graviditeten. Dessa stressiga omständigheter bidrar till att föräldrarna löper en ökad risk för posttraumatisk stress och depressiva symtom än föräldrar till fullgångna barn (Holditch-Davis et al, 2003; Holditch-Davis et al, 2015; Kong et al., 2013 & Singer på al., 1999). Dessutom påverkas samspelet mellan föräldrar och barn och familjesituationen negativt (Forcada-Guex et al., 2006; Saigal et al., 2000 & Treyvaut et al., 2014). När en förälder är psykiskt labil påverkar detta barnet på ett socialt, beteendemässigt och funktionellt sätt, ända till det för tidigt föda barnet är i förskoleåldern (Huhtala et al., 2011 & Huhtala et al., 2014). Det ger därför dubbel utdelning att ta hand om föräldrarna till tidigt födda barn, både genom att påverka den vuxne direkt och barnet indirekt.

    Svenska Prematurförbundet (SPF) har under flera år pekat på de långsiktiga effekterna av för tidig födsel och därmed behovet av långsiktigt stöd till de drabbade familjerna (Prematurförbundet, 2019). Efter utskrivning från sjukhuset rapporterar många av föräldrarna att de känner sig ensamma, stressade och oroliga. Sådana stödprogram har inte införts eller utvärderats tidigare i Sverige.

    Sammanfattningsvis, utifrån risken för negativa långtidseffekter av extrem prematuritet samt Prematurförbundets önskan om ytterligare stöd, finns ett tydligt behov av interventioner riktade till barnen och deras föräldrar i syfte att stödja föräldra-barnsamspelet, barnets utveckling på sikt samt föräldrarnas psykiska hälsa. SPIBI är et interventionsprogram som ämnar fylla det behovet.

    Metod

    SPIBI består av en tvärprofessionell forskargrupp med neonatologer, psykologer, fysioterapeut och specialpedagog. Forskargruppen har designat en RCT i syfte att utvärdera effekten av ett samspelsbaserat interventionsprogram för extremt prematurfödda spädbarn och deras föräldrar, med sin början i utskrivningsprocessen som pågår under förta året hemma. Studien består av två armar, en interventionsgrupp och en kontrollgrupp, och barnen rekryteras från Stockholms fyra neonatalavdelningar under två års tid (sept 2018-sept 2020). Målet är att rekrytera 130 familjer på två år. Interventionsgruppen (IG) får 10 hembesök och två telefonsamtal från en specialutbildad behandlare. Interventionens fokus är styrkebaserat stöd av föräldra-barnsamspelet, öka förälderns lyhördhet för barnets signaler, stödja föräldern i att ge optimalt utvecklingsstöd till barnet samt öka barnets självreglerande förmåga. I det nationella uppföljningsprogrammet får alla extremt prematurfödda barn uppföljning vid 3 månader, 12 månader, 24 månader KÅ. Kontrollgruppens (KG) barn får utöver detta ett utökat uppföljningsprogram.  

    Studiens sex behandlare arbetar inom neontalvården till vardags och har utöver detta fått en ettårig utbildning i SPIBI en dag per vecka, med både teoretisk grund och praktisk träning i interventionen, inklusive sex pilotfallshembesök. Pilotfallen videofilmades och diskuterades i grupp under handledning. Handledningen gavs direkt av de två holländska forskarna Karen Koldewijn och Marie-Jeanne Wolf från Amsterdam Academic Medical Centre som forskat på den snarlika TOP-interventionen i över 20 år och kunnat påvisa effekt på motoriken (Koldewijn et al., 2009; Meijssen et al., 2011; Flierman et al., 2016 & Koldewijn et al., 2010). Grunden till SPIBI interventionen kom utöver TOP-programmet från Cochrane-rapporten från 2015 om post-discharge interventions (Spittle et al., 2015).

    Resultat

    SPIBI är ett pågående forskningsprojekt som hittills rekryterat 44 barn, medan ytterligare 12 familjer tackat nej till deltagande i studien. I nuläget har två barn uteslutits ur studien av svåra psykosociala skäl och ytterligare två barn har avlidit under första året hemma. Identifierade utmaningar har varit den sociala och medicinska skörhet som de här familjerna behöver hantera, att hitta den optimala tvärprofessionella balansen mellan fysioterapeutiska, psykologiska, pedagogiska och medicinska inslag i interventionen, otillräcklig utskrivningsplanering från de olika sjukhusen, stor geografisk spridning på sjukhusenheterna samt den etiska frågan när i barnets liv det optimala tillfället för frågan om studiedeltagande är. Eftersom rekryteringsprocessen idag kommit halvvägs tidsmässigt kan inga resultat presenteras än, men med ett 80 % deltagande i studien och mycket positiv återkoppling från familjerna kan man dra slutsatsen att denna forskning är efterfrågad och ett viktigt nästa steg i utvecklingen av vården för våra allra mest sköra patienter.

    Slutsatser

    Slutsatsen är att SPIBI-protokollet är både genomförbart i klinisk praxis och samtidigt uppskattat av föräldrarna i målgruppen. Med hänsyn taget till den smala rekryteringsbasen kan denna typ av studie kräva en lång inkluderingstid alternativt inkludering på nationell nivå. Eftersom extremt prematurfödda barn och deras föräldrar uppvisar en rad svårigheter och utmaningar, är tvärprofessionellt samarbete att föredra vilket ställer höga krav på lyhördhet, professionell respekt och got om tid för samarbete. På Perinataldagarna kan forskningsprocessen och interventionsprogrammet presenteras i syfte att öka förståelsen för uppföljningen och behovet av ett integrerat föräldrastöd.

  • 2020. Erika Baraldi (et al.). International Journal of Environmental Research and Public Health 17 (24)

    With increasing survival rates of children born extremely preterm (EPT), before gestational week 28, the post-discharge life of these families has gained significant research interest. Quantitative studies of parental experiences post-discharge have previously reported elevated levels depressive symptoms, posttraumatic stress-disorder and anxiety among the parents. The current investigation aims to qualitatively explore the situation for parents of children born EPT in Sweden during the first year at home. Semi-structured interviews were performed with 17 parents of 14 children born EPT; eight parents were from an early intervention group and nine parents from a group that received treatment as usual, with extended follow-up procedures. Three main themes were identified using a thematic analytic approach: child-related concerns, the inner state of the parent, and changed family dynamics. Parents in the intervention group also expressed themes related to the intervention, as a sense of security and knowledgeable interventionists. The results are discussed in relation to different concepts of health, parent–child interaction and attachment, and models of the recovery processes. In conclusion, parents describe the first year at home as a time of prolonged parental worries for the child as well as concerns regarding the parent’s own emotional state.

  • 2021. Erika Baraldi. Specialpedagogik för lärare, 340-364

    Mer än en av tjugo elever är födda för tidigt och ett fåtal av dem föddes redan efter cirka halva graviditetstiden, de extremt för tidigt födda barnen. De här barnen har ofta varit svårt sjuka i livets början och en del av dem har varit nära att inte överleva sin ettårsdag. Det här kapitlet handlar om de här barnen och deras faniljer; hur skolans personal kan bli en viktig resurs att bidra till dessa barns utveckling och lärande, som de första personerna utanför familjen och medicinsk personal som gör skillnad för en helt ny grupp barn: de nya överlevarna som de kallats av nyföddhetsläkaren Hugo Lagercrantz. Hur kan förskolmiljön och pedagogiken i skolan anpasas så att det passar också de 5-6% elever som är för tidigt födda? I det här kapitlet presenterar vi forskning om hjärnans utveckling, för tidigt födda barn och autentiska fallexempel. 

Show all publications by Erika Baraldi at Stockholm University

Last updated: March 16, 2021

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