Centering Adolescents Group Prenatal Care Implementation in a Teen & Tot Clinic: Adaptation and Patient Reception Practicum Intern Sommer Barnes, Maternal & Child Health This program is funded by the Boston Public Health Commission and Boston Healthy Start Initiative

Background Adolescents may be at increased risk of adverse perinatal outcomes, and may be especially vulnerable and susceptible to sexually transmitted diseases and infections The Teen and Tot Program at Boston Medical Center is a program in Pediatric,s linking pregnant and parenting teenagers (≤21) to educational, social, and healthcare resources at BMC and in the community CenteringPregnancy is a group model of care in which participants practice self-assessment, health education, and build communities of support during and after pregnancy The Centering Healthcare Institute is currently developing materials and curricula for Centering groups dedicated to meeting adolescents’ needs Second bullet: teenagers

Introduction Implementation of exclusively adolescent CenteringPregnancy program in the Adolescent Clinic at BMC, as part of Teen and Tot Program 10 sessions, 6-8 teens, 16-20 weeks gestation, mostly African American and Latino in TTP Practitioners have prior experience with teenagers, and prior experience with Centering, but until now, these have not been combined Absence of mentoring relationship in mostly primiparous teenage cohort—but perhaps heightened peer support Discovering “What makes Centering work for teens”

Objectives Improve perinatal outcomes for adolescents Adapt established strategies for group prenatal care to a completely teenaged cohort Identify and pilot new care services tailored to teenage mothers’ needs Monitor patient satisfaction and health indicators to inform future groups

Goals Research established methods and evidence in group prenatal care delivery and outcomes Research developments in teen-specific materials and curricula Obtain appropriate materials and aid in adaptation to the Teen & Tot Program Make recommendations for future adolescent Centering groups at Boston Medical Center Assist in Monitoring and Evaluation through data collection

Activities & Rationale Conduct literature review of group care, particularly among adolescents to inform direction of research into appropriate methods and activities Participate in all CenteringPregnancy sessions as a participant-observer to facilitate nonthreatening educational sessions and provide outside input without disrupting the group model Keep detailed field notes for drawing qualitative analysis of group dynamics & patient attitudes, concerns, and adherence Obtain materials and curricula for implementing Centering with an all-adolescent cohort Training in Centering Counts data input for future evaluation of site fidelity and outcomes

CenteringPregnancy+ Project Contraceptives Family Assessment Personalization of Risk – HIV/STIs Staying safe in long-term relationships Personal Goals Actual v. ideal risk Effects of STDs on pregnancy/fetus STD/HIV myths & facts “Dear Centering” scenarios Triggers for unprotected sex Barriers & benefits to condom use Condom use instruction Communication strategies Safer Sex Goals for My Future

Main Findings Community and Relationship – shared mealtime, using one another’s names, introducing one another to the group, teaching and helping one another with weight measurement, blood pressure, etc. Teens often cite grandmothers as most supportive of pregnancy Effect of Support Persons – negativity, inconsistency vs. consistent positive support Partners’ confusion/understanding of role – fathers are interested but uncomfortable, inquire about group “just for us” Good feedback from patients, even from those for whom it is emotionally difficult.

Importance of established systems, routines, and personnel roles in practical implementation Need for “drawing out” the quiet ones to make patient-directed care equitable in a group Reminder: “This is your real prenatal appointment” Sense of humor Acknowledging, validating, and encouraging discussion of the good and the bad Emotional counseling and sharing coping strategies – from facilitator and from one another

Recommendations Incorporate self-esteem and goal orientation into teen curriculum addressing STI/HIV Compare outcomes of teens in mixed-age groups to outcomes among teen-only groups Evaluate the effect of partner Support Person upon single group members in a population with lower levels of partner involvement Incorporate partners and grandmothers as much as possible in STI prevention efforts Continue to foster partner/father involvement for those who are present Maintain perseverance with difficult patients

“Well, you’re gonna have to fight with me to get out of that tub because I want a water birth!” “I guess it’s hard, like it’s hard to find the right size or shape [of condom]. And it seems like some guys just need to have sex.” “Everyone at the shelter is wondering how I can run up and down the stairs so fast. I don’t know, my son is giving me energy.”