As a nurse midwife, Sharon Rising found that she often struggled to create a connection with her patients because the constraints of each appointments made meaningful interaction difficult. Yet she also knew as a health professional that such connection is necessary for providers to understand life events that can influence health of each patient – work pressures, conflict at home, unanswered questions about parenting. That is why Sharon created the Centering Healthcare model 25 years ago. The model, which structures appointments in patient groups, allowed her to spend more time with her patients and learn more about daily routines, social environments, and support systems. Addressing the complex social determinants of health such as where people live, work, and learn and other factors that influence health is the centerpiece of the way Community Health Centers approach care. In the case of the Centering Healthcare model, it can also be used to address a wide range of health conditions such as diabetes, pain management and more.
The model works by structuring visits with groups of 8 and 12 women who are in the same gestational stage and set to deliver around the same time. Together the patients go through 90-minute to 2-hour group visits beginning in the second trimester and meet every 4 weeks and later on every 2 weeks as they approach delivery. Built into these group health center visits is a health assessment, as well as one-on-one time with the provider.
The women also learn and discuss strategies for self-care and ways to be engaged in their health and the health of their babies. For example, they are taught how to take their own blood pressure and how to use growth charts for their babies. The women reunite a couple of months after giving birth (see photo). These visits encourage positive health behaviors, drive better health outcomes, and above all create a strong connection and sense of support among the expecting mothers. For some of the moms, these friendships provide a support system that would otherwise not exist.
More than 500 practice sites are currently using the prenatal model, and the number is expected to grow to 1,600 in the next five years.
A 2012 study found that the Centering Healthcare model narrowed health disparities between African American and white mothers. CCI Health & Wellness Services, a health center located in in Silver Spring, MD, has documented the impact of the Centering Model on their patient population. Only around 5% of patients had preterm births, compared to over 10% in the state of Maryland, and only 6% of patients in CCI’s Centering program experienced low birth rate, compared to nearly 10% for the state of Maryland.
Some providers, including CCI, also use the CenteringParenting model to teach caregivers healthy coping mechanisms, techniques for stress reduction, and tools to foster a strong parent-child bond.
“The model encourages you to figure out what really works for your patients” said Ana Sierra, an expert in the Centering Healthcare model at the Texas Association of Community Health Centers.
To learn more about Centering and bringing it to your health center, please register here for a webinar on Centering for chronic disease management featuring the Centering Healthcare Institute on June 13 at 3PM ET.
You can also access a recording of a May webinar on MyNACHC which features the Centering Healthcare Institute, CCI Health & Wellness, and the Texas Association of Community Health Centers as they discuss the Centering Pregnancy and Parenting models.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS16089, Technical Assistance to Community and Migrant Health Centers and Homeless for $6,375,000.00. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.