1. 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

2. 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

3. 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, 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”

4. 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

5. 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

6. 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

8. 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

9. 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.

10. 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

11. 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

12. “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.”