1. Group Prenatal Care and Group Baby Care With Refugees
Roberta Matern, MD
Lindsay Grizzle, MD
Family Medicine Residency,
St. Joseph’s Hospital
and Medical Center,
Phoenix, AZ
April 28, 2015

2. Disclosures
None

3. Objectives 1. List modifications needed to CenteringPregnancyTM and CenteringParentingTM to tailor them to refugees 2. Identify barriers to group prenatal care with refugees and discuss solutions 3. Describe how residents can be involved with these groups

4. St. Joes: Most patients on Medicaid Many refugees 8/8/8 program
6 faculty (4 providing OB care)
Centering with refugees for 6 years (IMP – International Maternity Program)

5. Health assessment
Education
Support
GROUP SETTING

6. Outcomes for Centering
 Preterm birth rates
Birth weights
 Initiation of breastfeeding
 Rates of contraception use
 Visit satisfaction for patients and providers

7. Benefits with refugees
MORE TIME
More education
Group support
Community building
Cultural competency education for residents
Troubleshooting
Increased efficiency by saying once to a group of women that which is much more time intensive if done individually & repeatedly.
More time to address pt questions that many of the others might share. Greater support and empowerment amongst one another.
For resident: different cultures to learn, but also ensuring proper methods of using phone or live interpreter and culturally sensitive interpersonal interaction.

8. Modifications to Centering
Regular Centering
Refugee Group
English/Spanish
Enrollment by EGA
Pts check wt/BP
Books for $20 each (English/Spanish only)
2 constant providers throughout
Centering curriculum
Language and culturally based groups
Rolling enrollment
Literacy level (we check wt/BP)
No books
Same attending/rotating residents (or focus on OB-minded residents)
Curriculum loosely Centering based with emphasis on health and safety
More in-depth syllabus/book vs. Topics (6 that repeat every 6 weeks for moms; 3 topics for baby groups) - amount info/breadth limited due to extra time req’d for interpretation and due to rolling enrollment.
Topics Include:
MOM
1. Health Choices in Pregnancy (foods, iron, choices)
2. Fetal Development & L&D (fetal growth, stages of labor, cervical dilation, placenta delivery)
3. What to Expect at Hospital During L&D (anesthesia, labor interventions, hospital stay, newborn screening)
4. Car Seats (securing infant, securing seat)
5. Oral Health (causes of decay, caregiver transmission of bacteria, baby bottle rot, care of teeth)
6. Postpartum Issues (menstrual cycle, non-hormonal/hormonal methods, PPD sx, bonding, BrF basics/benefits, colostrum, BrF video
*all topics make use of visual aids*
BABY
Infant Nutrition & Feeding (BrF problem solving, intro of solids, cow/goat milk, WIC)
Basic Infant Care & Safety (bathing, sleep, taking temp, tummy time, shaken baby, passive tobacco, sun safety, colic/crying)
Oral Health and Infant Bonding (bacterial transmission, bottle rot, cleaning teeth, PPD screen, maternal attachment, reading)
*developmental milestones & vaccinations every visit
*visual aids

9. Curriculum Prenatal 1. Healthy Choices in Pregnancy
2. Fetal Development & L&D
3. What to Expect at Hospital During L&D
4. Car Seats
5. Oral Health
6. Postpartum Issues
All with visual aids
Repeats every 6 months
More in-depth syllabus/book vs. Topics (6 that repeat every 6 weeks for moms; 3 topics for baby groups) - amount info/breadth limited due to extra time req’d for interpretation and due to rolling enrollment.
1. Healthy Choices in Pregnancy (foods, iron, choices)
2. Fetal Development & L&D (fetal growth, stages of labor, cervical dilation, placenta delivery)
3. What to Expect at Hospital During L&D (anesthesia, labor interventions, hospital stay, newborn screening)
4. Car Seats (securing infant, securing seat)
5. Oral Health (causes of decay, caregiver transmission of bacteria, baby bottle rot, care of teeth)
6. Postpartum Issues (menstrual cycle, non-hormonal/hormonal methods, PPD sx, bonding, BrF basics/benefits, colostrum, BrF video
*all topics make use of visual aids*

10. Curriculum BABY Infant Nutrition & Feeding Basic Infant Care & Safety
Oral Health and Infant Bonding
*developmental milestones & vaccinations every visit
*visual aids
Repeats every 6 months
Infant Nutrition & Feeding (BrF problem solving, intro of solids, cow/goat milk, WIC)
Basic Infant Care & Safety (bathing, sleep, taking temp, tummy time, shaken baby, passive tobacco, sun safety, colic/crying)
Oral Health and Infant Bonding (bacterial transmission, bottle rot, cleaning teeth, PPD screen, maternal attachment, reading)
*developmental milestones & vaccinations every visit
*visual aids

11. Barriers Communication Transportation Logistics Staff Training Funding
Recruitment

12. Communication
Remember, clinics that receive funds from federally funded program (Medicaid) MUST provide interpretation
Live interpreters (ideal)
Usually from the IRC
Sometimes from state Medicaid plans
Cyracom
Communication
--During visit – live vs. cyracom
--Outside of visit – siphon calls to specific --front office person/personal phones
--front office person/personal phones

13. Transportation Community partners IRC Catholic Charities
Lutheran Social Services
Medicaid taxi vouchers
Probably our biggest barrier
Takes a HUGE amount of staff time with phone calls/reminders/ s/etc

14. Logistics/Staff 1-2 attendings 1-2 RNs and/or MAs
Residents and medical students
Other staff dedicated to fielding calls from refugees and coordinating appointments and rides
Adept with Cyracom AND the system AND the agencies
CLINIC, RESIDENCY, MANAGERS AND EVERYONE FROM CMO DOWN HAS TO BE ON BOARD
Coordination of care
--largely takes place during the visit (depends on level of IRC involvement)

15. Training/Funding Revolving door of residency faculty
Centering workshops
Usually on faculty’s own CME dime
March of Dimes
First Things First
Innovative grants
Phoenix Children’s Hospital

16. Recruitment Not easy to get enough patients Community partners
Visit communities
CHC
IRC
Lutheran Social
Churches
Word of mouth
Prior patients

17. Resident involvement
1-2 teaching sessions on facilitation and Centering per year
R2/R3 with interest in OB
Each session with the same 1-2 attendings as co-facilitators
Review language, culture, curriculum, props and plan prior to session
Reinforces use of interpreters, facilitation skills, use of patient-friendly and culturally-friendly language

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