1. Centering Parenting: Meeting the needs of parents J. Cyne Johnston, PhD and Cheryl MacLeod, RN MEd

2. 2 Outline Group Parenting Programs Centering Parenting Centering Parenting within AHS –Development –Implementation –Evaluation Future Plans

3. 3 Transitions

4. 4 Traditional One-to-One Support

5. 5 Group Care

6. 6 Key Concepts for Group Care Client and Provider Satisfaction Family Centered Care Facilitative Empowerment Peer Support Capacity Building

7. 7 Group Parenting Interventions Short-term improvement in parental depression, stress, confidence and anxiety (Barlow, et al. 2012) Early support for improvement of child emotional and behavioural adjustment (Barlow et al. 2012)

8. 8 Other Supporting Work Peer Support for improving breastfeeding duration (Jolly et al. 2012, Renfrew et al. 2012) Early evaluation work from other Centering Parenting programs shows some signs of improved maternal BMI

9. 9 Centering Parenting A model of group care for well-woman and well-baby » Health assessment » Education » Peer and Professional Support » Immunization

10. 10 Each 2 hour session 30- 45 minutes Check-in and individual assessments with the provider 45-60 minutes Formal “circle-up” or facilitated discussion time 30-45 minutes Vaccinations and informal socialization Closing and follow-up as needed

11. 11 Maternal and Infant Self-Assessment

12. 12 Provider Assessment Each dyad has an individual assessment with the health provider Normal triage done Questions are saved for the group session

13. 13 Group Session

14. 14 8 parent/infant dyads and 2 PHN facilitators All activities occur within the group space The group is conducted in a circle Each session has an overall plan with core content; emphasis may vary depending upon the needs of the group Group members are involved in self-care activities, weighing, examining, assessing infants and selves. Opportunity for socializing within the group is provided There is on-going evaluation of outcomes Key Elements of Centering Parenting

15. 15 Paradigm Shift Traditional Care Group Care Directive Expert-led Education random and provider dependent Few opportunities for socialization with others Facilitative Shared ownership of health More time for education, shared with all Opportunity for socialization, peer-to-peer support

16. 16 Centering Parenting in Calgary Public Health Clinics

17. 17 Centering Parenting Project within AHS Stage 1 –Received a $10K grant from the Alberta Centre for Child, Family, and Community Research –Development of the universal program and content –Focus groups with parents, PHNs, parenting experts –Adaptation and integration of U.S. Centering Parenting curriculum –Development of research proposal

18. 18 Adapting to local context Curriculum Vaccination delivery system Public health nursing led Visit time points: 1,2,4,6,9,12 months

19. 19 What have we learned so far… Parents: “I didn’t have a support network: other mothers who were feeling the same things I was feeling.” “The most valuable component is connecting with other parents.”

20. 20 What have we learned so far… PHNs were excited about a new model of providing care and having additional opportunities for professional growth.

21. 21 Parenting Experts There was considerable support from local parenting and child development experts “[The program] has really good adult learning principles and parenting education practices as well… It’s fabulous.” “I really think that it’s only getting them there once. Once you get them to [the group] they’re hooked. I truly believe that.”

22. 22 Centering Parenting Calgary Zone Stage 2- Current Work –Received grant from the Alberta Centre for Child, Family, and Community Research –Funding for: Staff training and a feasibility study of Centering Parenting for 32 parent/infants in 2 locations –Recruiting now!!! Intervention to begin November 2013

23. 23 Research Questions for the Feasibility Study Is it feasible to implement a Centering Parenting group intervention In the Alberta context? How do the pilot results compare to pre-intervention measures, available local data, and/or established norms?

24. 24 Centering Parenting Calgary Zone Research Methodology –2 communities selected for pilot – 1 urban (East Community Health Centre) and 1 suburban/rural (Airdrie) –Two groups will be run concurrently at each site –7-8 mother/infant dyads recruited in each group (28- 32 in total) –Families will attend 6 X 2 hour sessions (@1,2,4,6,9,12 months)

25. 25 Centering Parenting Calgary Zone Data Collection Tools, Measures, Health Indicators Maternal BMIProgram costs Child growthQualitative interviews Social support Postpartum depression Parenting moral index Parent and clinician satisfaction Parenting stress Breastfeeding initiation/duration

26. 26 Centering Parenting Calgary Zone Stage 3 – Future Work –Randomized Trial –Additional external funding will be sought if the pilot is acceptable to PHNs, parents, AHS.

27. 27 Challenges

28. 28 Shift in Practice Moving from directive to facilitative

29. 29 Logistical Issues Physical space for a group that’s appropriate for groups of parents and infants Scheduling and shift changes Recruitment of parents

30. 30 Stakeholder Support

31. 31 Provincial and International Interest Considerable interest from: Alberta Health Centering Healthcare Institute Other Alberta Health Services Zones Primary Care Networks

32. 32 Key Points Early parenthood is a time of great transitions Group parenting programs have the potential to provide an effective intervention to improve the health of children, parents, and families There is demand for a group well-child visit among parents, PHNs, and parenting experts Centering Parenting Pilot is ready for implementation in 2 Calgary-area sites

33. 33 Special Thanks to Project Team Cheryl MacLeod Donna Wallace Shelly Philly Deborah A. McNeil Germaeline van der Lee Kaitlyn Hill Joanne Coldham Sandy Phillips Lynn Headley

34. 34 Special Thanks Alberta Centre for Child, Family and Community Research Alberta Health Services University of Calgary

35. 35 Contact Information Cyne Johnston Cyne.johnston@albertahealthservices.ca Cheryl MacLeod Cheryl.macleod@albertahealthservices.ca