1. Carmen Strickland, MD, MPH October 28, 2009 Centering Models: Group Care for Improved Perinatal Outcomes

2. Centering Healthcare Institute, Inc CenteringPregnancy CenteringParenting

3. CenteringPregnancy: Recruitment Initial intake to system as usual (History, physical, lab work) Invite 8-12 women with similar due dates into the group

4. CenteringPregnancy: Schedule Four sessions every 4 weeks 16, 20, 24, 28 weeks Six sessions every 2 weeks 30, 32, 34, 36, 38, 40 weeks Plan for a reunionBetween 1-2 months postpartum Additional visits as needed to address issues

5. Design: Two-Hour Session 30-40 minutes Check-in and individual assessments with the provider 60-75 minutes Formal “circle-up” or facilitated discussion time Informal time for socializing Closing and follow-up as needed

6. Centering: a model for group health care EDUCATION ASSESSMENT SUPPORT

7. CenteringPregnancy- Forsyth County Southside United Health and Wellness Center Governed by community board Funding: Winston-Salem Foundation Kate B Reynolds BC/BS Winston-Salem State School of Health Sciences (in-kind donation of equipment) March of Dimes: Centering Pregnancy Implementation

8. Program Characteristics Reimbursement: Same as Traditional PNC Demographics: All populations served Services offered:Endless possibilities … Dental Family Planning Nutrition Lactation WIC/Baby Love

9. National Institute of Mental Health #MH 61175, 2001-2006 Ickovics, et al. (2007)Obstetrics & Gynecology. 110(2):3230-9. Effects of Group Prenatal Care: Randomized Control Trial

10. Outcomes: Preterm Birth Decreased rate of preterm birth (OR 0.67, 95%CI 0.44-0.99) Decreased rate of preterm birth among African American ( OR=.59; 95%CI 0.31-0.92)

11. 78% average attendance rate for group participants Significantly higher prenatal knowledge and readiness for labor & delivery (each p<.001)* Greater rates of breastfeeding initiation (66.5% v 54.6% p<.001) Significantly greater satisfaction with care (F=27.2, p<.001) No difference antenatal or delivery costs (p>0.69) Secondary Outcomes: 2006 Randomized Control Trial *Planned contrast CP+/CP vs control; measured post-intervention Ickovics, et al. (2007) Obstetrics & Gynecology. 110(2): 3230-39.

12. CenteringParenting Group well child and first postpartum year care Similar model: shared visit, structured around standard immunization schedule

13. CenteringParenting Family planning/contraception Preconception health (nutrition/folic acid; exercise/wt.management; substance abuse) Mental health OPPORTUNITY for Interconception care of the new Mom

14. “ We came at the same time and left at the same time and something happened the whole time we were there. ” - Group Participant “ I am learning that it doesn’t matter what we don’t talk about, because we are talking about what matters to the group. ” “ In truth, I continue to be awed by the power of the group. We are having such a good time and have such laughs. - Claire Westdahl, CNM

15. CHI 558 Maple Avenue Cheshire, CT 06410 203-271-3632 info@centeringhealthcare.org www.centeringhealthcare.org