Carmen Strickland, MD, MPHOctober 28, 2009

Centering Models: Group Care for Improved Perinatal Outcomes

Centering Healthcare Institute, Inc

CenteringPregnancy

CenteringParenting

CenteringPregnancy: Recruitment

Initial intake to system as usual(History, physical, lab work)

Invite 8-12 women with similar due dates into the group

CenteringPregnancy: Schedule

Four sessions every 4 weeks

16, 20, 24, 28 weeks

Six sessions every 2 weeks

30, 32, 34, 36, 38, 40 weeks

Plan for a reunion Between 1-2 months postpartum

Additional visits as needed to address issues

Design: Two-Hour Session

30-40 minutes Check-in and individual assessments with the

provider

60-75 minutes Formal “circle-up” or facilitated discussion time

Informal time for socializingClosing and follow-up as needed

Centering: a model for group health care

EDUCATION

ASSESSMENT

SUPPORT

CenteringPregnancy- Forsyth CountySouthside United Health and Wellness Center

Governed by community boardFunding:

Winston-Salem Foundation Kate B ReynoldsBC/BSWinston-Salem State School of Health Sciences (in-kind

donation of equipment) March of Dimes: Centering Pregnancy

Implementation

Program Characteristics

Reimbursement: Same as Traditional PNCDemographics: All populations servedServices offered: Endless possibilities

…DentalFamily PlanningNutritionLactationWIC/Baby Love

National Institute of Mental Health #MH 61175, 2001-2006

Ickovics, et al. (2007)Obstetrics & Gynecology. 110(2):3230-9.

Effects of Group Prenatal Care: Randomized Control Trial

Outcomes: Preterm Birth

Decreased rate of preterm birth (OR 0.67, 95%CI 0.44-0.99)

Decreased rate of preterm birth among African American (OR=.59; 95%CI 0.31-0.92)

78% average attendance rate for group participants

Significantly higher prenatal knowledge and readiness for labor & delivery (each p<.001)*

Greater rates of breastfeeding initiation (66.5% v 54.6% p<.001)

Significantly greater satisfaction with care (F=27.2, p<.001)

No difference antenatal or delivery costs (p>0.69)

Secondary Outcomes: 2006 Randomized Control Trial

*Planned contrast CP+/CP vs control; measured post-intervention Ickovics, et al. (2007) Obstetrics & Gynecology. 110(2): 3230-39.

CenteringParenting

Group well child and first postpartum year care

Similar model: shared visit, structured around standard immunization schedule

CenteringParenting

Family planning/contraceptionPreconception health (nutrition/folic acid; exercise/wt.management; substance abuse)

Mental health

OPPORTUNITY for Interconception care of the new Mom

“ We came at the same time and left at the same time and something happened the whole time we

were there. ”- Group Participant

“ I am learning that it doesn’t matter what we don’t talk about, because we are talking about what matters to the group. ”

“ In truth, I continue to be awed by the power of the group. We are having such a good time and have such laughs.

- Claire Westdahl, CNM

CHI558 Maple AvenueCheshire, CT 06410

203-271-3632info@centeringhealthcare.orgwww.centeringhealthcare.org