1. Janet Seabrook M.D., MBA CEO Community HealthNet Health Centers

2.  Incorporated in the State of Indiana in 1998  Became a Federally Qualified Health Center (FQHC) in 2006  CHN had over 31,000 patients visits in 2013  CHN has 5 locations in Northwest Indiana

3. These are the facts surrounding a few of the Social Determinants of Health in Lake County  The percentage of children in single parent households is 41.6% vs. 30.8% in the U.S.  The percentage of individuals living in poverty is 19.6% while the percentage in Gary is >30.1%  The percentage of children in poverty is 31.3% vs. 23.9% in the U.S.  The unemployment rate is 9.2% vs. 17% in Gary  The statistics for violent crime are 402.6/100,000 vs. 199.2/100,000 in the U.S., the rate for Marian County is 1124.5/100,000  The percentage of individuals who are low income and do not live close to a grocery store in Lake County is 8.1% vs. 6.2% in the U.S.  Average annual concentration of PM 2.5 is 14.6 ug/m3 in the U.S. the median is 10.7 ug/m3 (this refers to particles, pollutants and air quality

4.  The median income in Lake County is $48,341 (2013), the city of Gary’s median income is $28,056 vs. Indiana at $62,638 The number below are from the U.S. Census Bureau website (quick stats) Gary, IndianaLake County, Indiana population80,314490,228 Caucasian9.1%70.9% African American 84.3%25.3% Latino5.1%18.1% Two or more races 2.1%1.8% Asian0.2%1.5%

5. In 2013, the Northwest Indiana Times newspaper reported Lake County’s Infant Mortality number following a visit from the Health Commissioner for the State of Indiana. 7.9 per 100,000 live births (Lake County) 7.7 per 100,000 live births (Indiana) 12.3 per 100,000 live births (A.A. in Indiana)

6. Community HealthNet’s management, along with the nurse midwife implemented a plan to begin a “Centering Pregnancy” Program at our health center in 2011 following a Community Needs Assessment. In 2011, Community HealthNet wrote a grant to request funds from the March of Dimes Indiana to pilot a “Centering Pregnancy” Program.

7. Leah Staples RN, CNM, AFNP Lead facilitator Marie Crisler, MA Centering/Prenatal Coordinator Vinnette Donaldson, RN Nurse educator Cherry Rosser, MA Prenatal staff

8. Community HealthNet requested the funding to implement a pilot project using the Centering Model of care as a means to reduce the infant mortality among the patients of the health center A 2012 study in the American Journal of Obstetrics and Gynecology found a 47% reduction in preterm births for women in a Centering program compared to women in traditional maternity care

9. What is Centering Pregnancy?  Group Prenatal visits that provide 3 components of prenatal care  Assessment of the mom and the baby  Education of the mom and significant others  Support of the mom, the baby and family

10.  Centering Pregnancy creates a warm nurturing environment for the mom to be and her support system  As the Centering Pregnancy Program has evolved CHN staff noted that without any prompting peer to peer mentors, household and community leaders are emerging among the participants  Points of discussion in group can cover a wide range of topics (such as breastfeeding, tobacco cessation and nutrition)  Where to shop, what are the best prices, who has the best daycare…Are some of the discussions that families are having after each session

11. Group Model Centering Pregnancy  Initial intake done before 1st session  First group session is usually started when the moms are between 12-16 weeks  Groups of 8-12 women, with similar due dates are placed together  Moms will do their own weight and blood pressure  An individual physical assessment is done within the group space by the provider

12.  10 Sessions lasting two hours each and they are facilitated by a group leader  4 Sessions occur every 4 weeks: 16,20,24,28  6 Sessions occur every 2 weeks 30,32,36,38,40/PP

14.  Self Monitoring  Mom checks her own BP  Weight  Mom makes notations of the data for her record

15. The Check-up

16. Prenatal Physical Assessment Fundal height Fetal heart tones Fetal position

18. Education Comfort Issues Risks of tobacco and its effects on the baby (CHN is a pilot project for “Baby and Me Tobacco Free” Exercise/relaxation Nutrition Childbirth preparation Sexuality Postpartum changes and depression assessments using SBIRT or the PQH 9 resources a completed on each mother

19. Education  Communication/self esteem  Issues of Abuse  Baby Care  Infant Feeding  Parenting  Contraception

20. Support Refreshments Formal and Informal Sharing and Networking Stability of the group members and a reduction in no show rates Exchange of names, telephone numbers Consistency of leadership by the healthcare team which leads to a decrease in provider shopping

21. Support

22. Support…..Community Building

27.  Group 1 started November of 2012  11 women completed Centering  Group 2 started in January of 2013  8 women completed Centering  Group 3 started March of 2013  5 women completed Centering  Group 4 started October of 2013  5 women completed Centering

28.  Group 5 began on March 19, 2014  15 women completed the program  Group 6 began on April 2, 2014  10 women completed the program  There have been challenges such as finding a time that is suitable for the majority to obtain optimum attendance other challenges include transportation and childcare

29.  As of October 22, 2015 Ten (10) groups have completed “Centering Pregnancy”  A total of 86 healthy babies have been delivered as a part of the “Centering Pregnancy” Program  Groups 11 and 12 are currently in session and due in the in February/March of 2016

30. Next Steps Centering Parenting Mother-Baby care for the first year of life and beyond... Groups of 5-6 mothers/babies with similar birthdays Groups begin about 2 weeks after birth…or the Centering Pregnancy group continues to meet for 10 an additional sessions throughout the first year of life with the focus on Parenting and Life Skills

31. Centering Pregnancy Our health center is building relationships and community Our health center is assisting in creative problem solving Our health center is creating an efficient means to educate Our health center is creating a vehicle for social change CHN is “CENTERING” as a means to reduce Infant Mortality in Lake County

32.  Visit the Centering Pregnancy Institute website for more information on Centering  Become an advocate for Centering Pregnancy  www.citydata.comwww.citydata.com  www.statsindiana.edu www.statsindiana.edu  Nwitimes.com  U.S. Census Bureau

33. Thank you Questions???