1. Background
Centering®
is an evidence-based group model of healthcare that is changing
the way we give and receive care. Through CenteringPregnancy®
and
CenteringParenting®
, health assessment, interactive learning, and community
building all happen in the group space. Centering is getting patients out of the
exam room and into conversation with one another.
In CenteringPregnancy group prenatal care, 8-12 women of similar gestational
age receive all their care in group. In CenteringParenting well-mom, well-baby
care, a cohort of 6 to 7 mothers and infants come together for care during
the first two years of life. When implemented in succession, these models
exemplify the life course principles of continuity and interconception care and
offer unique opportunities for linking patients and families with other health
and support services. These models effectively move health and healthcare
beyond the clinical, creating a truly family-centered approach. Moreover,
these models aid in the development of interdisciplinary healthcare teams,
minimizing silos and structural barriers to care.
Centering is patient-centered care that increases both patient and provider
satisfaction. There are over 400 Centering practice sites across the United States
and a national office, Centering Healthcare Institute (CHI), in Boston, MA.
Methods
Reports generated from CHI’s Salesforce database were used to determine the
number of practices by model and approval status, the geographic distribution
of dual model practices, and when practices’ implemented each model. Health
outcomes data and qualitative data were pulled from practices’ Continued
Approval Reports, which are annual reports CHI requires to maintain Site
Approval status.
Health
Assessment
Community
Building
Interactive
Learning
Promoting Lifecourse Care – Lessons Learned
One of the dual model Approved practices, Practice 2, provided
additional insight into system-level decisions that helped ensure both
models could thrive.
Integrate & Engage the Steering Committee
“The Steering Committee makes decisions related to the Centering
groups, including when to open or close groups as well as staffing needs
at particular sites. The Steering Committee helps with patient recruitment,
curriculum decisions, and staff improvement and also problem solving
to ensure the success of Centering at each location. The Steering
Committee also reports to the MCH leadership committee...”
Designate a Centering Coordinator
“… [she] handles all of the administrative and logistical responsibilities related
to Centering, including group scheduling, In-House trainings, and chairing our
steering committee. Having a coordinator to handle these responsibilities has
enabled us to significantly increase the number of CenteringPregnancy and
CenteringParenting groups offered at our three sites.”
Adopt an Opt-Out Model
“…we have changed our mindset and now create a CenteringParenting
group for every CenteringPregnancy group that delivers... This creates
more of an “opt-out” approach to our CenteringParenting groups and
makes scheduling easier since we can plan in advance. This led to us
starting the largest number of CenteringParenting groups yet in 2014...”
Cross-Train Providers
“Cross-training a number of our family practice providers and co-
facilitators has enabled us to provide continuity of care to our Centering
patients, which has been rewarding for both our staff and patients.”
Conclusion & Next Steps
The Centering continuity model of care is a promising approach for
adopting a lifecourse framework for prenatal, postpartum, interconception,
and pediatric care. Furthermore, it is an excellent venue for mitigating toxic
stress, strengthening parent-child attachment, and encouraging positive
parenting. Dual model practices report improved maternal child health
outcomes and high patient and provider satisfaction.
A key component of CHI’s strategic plan in the coming
years is to increase the number of dual model practice
sites. The first phase of this endeavor includes updated
CenteringParenting patient and provider materials
better aligned with American Academy of Pediatric
guidelines. Secondly, CHI will engage Centering
stakeholders and providers to inform the additional
service offerings and policies needed to support
dual model expansion. As the number of dual model practices
increase, further research is needed to affirm the positive trends seen in
existing locations. CHI will work to identify grant opportunities for research
and advise researchers throughout the expansion efforts.
Locations
There are currently 32 practices offering both
CenteringPregnancy and CenteringParenting in
16 states. The largest concentration of dual model
practices is Ohio (n=6).
CenteringPregnancy®
and CenteringParenting®
:
The Centering®
Approach to a Life Course Model of Continuity Care
Molly Ryan, MPH, Alia Rawji, Shannon Sweeny
CenteringPregnancy:
• Labor and Delivery
• Family Planning
• Nutrition
• Exercise
• Stress Management
• Breastfeeding
• Infant Care
CenteringParenting:
• Attachment
• Language and Early Literacy
• Developmental Milestones
• Feeding
• Sleep
• Positive Discipline
• Toxic Stress
Health Outcomes
Five practices representing three health systems have achieved Site Approval for both
CenteringPregnancy and CenteringParenting. Data from four of these practices (two health
systems) are presented below.
CenteringPregnancy Health Outcomes
CenteringParenting Health Outcomes
% Low Birth Weight % Preterm Births
% Breastfeeding at
Discharge
% Patient Satisfaction
% Staff
Satisfaction
Practice 1
(N=101)
3.0% 6.0% 95.0% 95.0% 89.0%
Practice 2
(N=184)
4.8% 2.8% 79.0% 80.3% 87.3%
%
Breastfeeding at
6 months
%
Breastfeeding at
6 weeks
% Infants
Receiving
Appropriate
Immunizations
% Infants
Receiving
Developmental
Screenings
% of Mothers
Receiving
Postpartum
Depression
Screen
% of Mothers
Receiving
Domestic
Violence Screen
% Patient
Satisfaction
Practice 1
(N=47 dyads)
74.5% 85.1% 90.7% 100.0% 100.0% 100.0% 95.0%
Practice 2
(N=68 dyads)
41.0% 100.0% 96.0% 99.0% 100.0% 98.0%
Years Between Model
Implementations
All practices offering both models
started CenteringPregnancy first. The
median number of years between model
implementations is 1 year, with 83% of
practices implementing CenteringParenting
within 3 years.
Site Approval by Model
Site Approval is a model fidelity and
sustainability milestone that most practices
achieve two years into implementation. It is
official recognition that a Centering site has
met the standards that are specific to the
model and its Essential Elements.
All CenteringParenting Approved sites are
CenteringPregnancy Approved also. Overall,
CenteringPregnancy Approval is significantly
higher than CenteringParenting Approval.
0 1 2 3 4 5 6 7 8
7
8
4
5
2 2
1
NumberofSites
Years Between CenteringPregnancy & CenteringParenting
CenteringPregnancy
Only
23
CenteringParenting
Only
0
Dual Model
Approved
5