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CenteringParenting

A group medical visit becomes a community where parents learn from their healthcare team and one another.

Photo of Marena Burnett
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Updates: How has your idea changed or evolved throughout the Prize? What updates have you made to this submission? (1500 characters)

The opportunity to serve as both a mentor and an innovator in the challenge has been a valuable experience. The time spent in preparation for the calls and in conversation led me to be more specific in my own submission, and brought clarity to the type of support we are seeking.

Name or Organization

The Centering® Healthcare Institute (CHI) is a 501c3 organization that is partnering with a research team led by Dr. Renee Boynton-Jarrett, an Associate Professor of Pediatrics at Boston University School of Medicine/Boston Medical Center. If selected, the funding would support an Evaluation of the Impact of the CenteringParenting Intervention on Kindergarten Readiness in Early Childhood randomized controlled trial.

Geography

CHI is headquartered in Boston, MA. Centering is implemented in healthcare settings across the U.S.

What is your stage of development?

  • Advanced Innovator with 3 to 10+ years of experience in ECD

Type

  • Non-profit

What is the stage of your proposal?

  • Full-scale roll-out: I have completed a pilot and analyzed the impact of that pilot on the users I am trying to reach with my idea. I am ready to expand the pilot significantly.

Describe how your solution could be a game-changer for your selected Opportunity Area (600 characters)

Centering brings families and their healthcare team together throughout the critical period of health and development (prenatal – age 3). Parents are particularly open to behavior change and feedback during pregnancy and the first years of a child’s life, which encourages ongoing learning and sets a foundation for positive parenting. They receive the highest quality of care and, as part of an ongoing group, form a supportive community where they gain knowledge, skills and confidence regarding their child's health, safety and development.

Select an Innovation Target

  • System design: Solutions that target changing larger systems.

Tell us more about your innovation (1500 characters)

Early life experiences influence brain development and have significant implications on future health and developmental outcomes. Children raised in environments with limited stimulation and exposure to positive interactions are likely to have delays in expressive and receptive language, vocabulary, social skills, behavior - all factors critical for school readiness. Disparities in early childhood are associated with familial factors, including parental education, income, mental health and life circumstances. CenteringParenting, a two generation intervention, supports healthy parent-child interactions and early learning through education and experiential learning within the framework of group well-child visits. Continuing on from CenteringPregnancy prenatal group care or starting when 6-8 parents (or caregivers) and their infants of the same age are brought together, the group meets for 1.5 - 2 hour sessions following the American Academy of Pediatrics (AAP) Bright Futures™ schedule of visits. Participation reduces social isolation and creates a community of support for parents and caregivers, empowering them with knowledge and skills to support optimal child development.

What problem are you aiming to solve? (3 sentences)

Disparities in early childhood development increase risk for stunted academic achievement and can impact future life chances, social and economic opportunities and overall wellbeing. Primary care is a nearly universal exposure in early childhood and therefore is a significant entry point for promoting optimal child development. There is a need to provide effective, low-cost and scalable interventions, such as CenteringParenting, in primary care to support early childhood development.

Explain your idea (5000 characters)

The primary care visit, also referred to as the well-child visit, is an opportunity to provide parents with the knowledge and skills to support their child throughout the critical period of health and development (prenatal – age 3). Imagine a two hour well-child group visit where participants receive the highest quality of clinical care, benefit from facilitated discussions and experiential learning, and are empowered as they learn from their healthcare team and one another. CenteringParenting brings 6-8 parents, caregivers and support people with their same-age infants together in community with their healthcare providers and other caregivers who are experiencing similar things at the same time. In each two hour visit parents have a one-on-one assessment with the provider and then have time for group discussion and learning. This two generation intervention reduces social isolation and creates a community of support for caregivers, as well as utilizes a positive parenting approach to empowering parents with knowledge and skills to support optimal child development. CenteringParenting participants are actively engaged in their child’s assessment at every visit: tracking their growth, development, immunizations and oral health. Health assessments, immunizations and developmental screenings follow the AAP Bright Futures™ nationally recognized guidelines. This active participation makes them more aware of the results and what these health indicators and milestones mean to their child’s health, growth and development. Once health assessments are complete, group members and the provider team "circle-up" for interactive activities designed to address important and timely topics. CenteringParenting groups explore a broad range of topics including attachment, safe sleep, breastfeeding, nutrition, early literacy, child development and safety issues. When planning each session, the group facilitators are encouraged to include an activity, materials or discussion that highlights healthy parent-child interactions at that developmental stage. Early language and literacy development begins in the first months of life and is closely linked to a child’s earliest experiences of loving, everyday interactions such as talking, singing and reading. In a CenteringParenting group there is ample time for important learning activities and discussions, and for modeling the development stimulating behaviors (talk, read, play) with serve and return, early language interactions, reading, baby sign language, finger plays, music and movement. Group facilitators are encouraged to read books aloud at every visit to model the importance of reading as part of the family’s everyday routines. Additional resources such as developmental specialists, behavioral health, nutrition, dental care and other pediatric interventions can be incorporated into the Centering visit, destigmatizing these important support components and enabling a warm handoff to further care. There are opportunities to introduce other community social supports and national programs, such as Reach Out and Read. Providing care in this way allows group members and providers to relax and get to know each other on a much deeper and meaningful level. Participants form lasting friendships and support systems that connect them in ways not possible in traditional care. Anecdotal feedback from CenteringParenting practices suggest that both patients and providers prefer this approach to care, with emphasis on the unique opportunities for parental learning and community building. However, the widespread adoption and growth of the CenteringParenting model has been limited by the lack of an evidence base and we are actively seeking additional funding to accelerate research efforts.

Who benefits? (1500 characters)

The children, parents, families and other caregivers are ultimately the greatest beneficiaries of the CenteringParenting experience. To date the this model has been successfully implemented in 50 healthcare practices across the U.S. While sustainable in every type of healthcare setting, the greatest concentration is found in Federally Qualified Health Centers (FQHCs), community and hospital clinics. CenteringParenting can be offered as a standalone model of pediatric care or with families continuing on from their CenteringPregnancy groups, after their child’s arrival. This continuity model is where we believe it may have the greatest potential impact (P-2). Some of the existing health centers have extended CenteringParenting groups far beyond the 24 month well child visit in response to the demand from both patients and providers.

What kind of impact will your idea have? (1500 characters)

In over 100 published studies and peer reviewed articles CenteringPregnancy has been proven to lower the risk of preterm birth, close the disparity gap in preterm birth between black and white women, increase breastfeeding rates and improve both visit attendance and patient satisfaction. However, it was not until the first randomized control trial was published in 2007 that the model began to spread nationwide. Once an innovation develops an evidence-base (especially in healthcare) it attracts not only champion healthcare providers but also healthcare leadership, the payer sector and funders. To date there is no evidence base to support the benefits of the CenteringParenting intervention on school readiness, or improvements in parental behaviors that support optimal developmental milestones and achievement. We believe that the cluster randomized controlled trial proposed by Dr. Renee Boynton-Jarrett will make a significant contribution to our understanding of how the CenteringParenting intervention may positively impact the developmental and behavioral trajectory of children ages 0 to 2 years, and which will lead to widespread adoption of the model across healthcare systems.

How does or how could your idea impact low-income children? (1500 characters)

Early life experiences influence brain development and have significant implications on future health and developmental outcomes. Low income children are at greatest risk of developmental delays in large part due to a lack of an enriched environment. Disparities in early childhood development increase risk for stunted academic achievement throughout the life course. When CenteringParenting becomes the standard of care ALL parents and caregivers will have access to the information and social support they need to be more informed, confident and empowered to make healthier choices for themselves, their children and their families.

Innovation: What makes your concept innovative? (5000 characters)

Primary care is a universal exposure in early childhood and is a significant entry point for promoting optimal child development. CenteringParenting is the billable primary care visit, not an additional program or class, and can be an effective, cost neutral, scalable intervention. Bringing families together for care in this innovative way is a profound change to the way healthcare is delivered. Learning in a group visit is a much different experience that the historical didactic approach in primary care where patients (parents) are passive listeners and health professionals can only guess what information is actually being absorbed or accepted. Centering is based on the principals of adult learning, which demonstrate that when someone is actively involved and engaged they learn and retain information more than when they are lectured to and/or read something. We also recognize that greater understanding and retention come about with activities that engage many senses. The result of providing care this way is a deeper and more meaningful exchange of ideas. It is through sharing and being heard in a group that participants begin to claim their own knowledge and are empowered to be collaborative partners in their child’s care. Centering participants report feeling more informed, better prepared and supported. Providers have a unique opportunity to listen to the joys and concerns of patients in group medical visits and to gain an understanding of the life experiences, cultural beliefs and values that guide their behaviors. The two hour group visit format allows the healthcare team to observe the parent-child interactions, model behaviors and developmentally appropriate activities, and for the group to explore the topics that matter most.

Scale: Describe how your idea could reach a significant number of end-users. (1500 characters)

We define success as greater access to Centering group care, more patients served and increased opportunity to impact birth and life-course outcomes. To spread this life-affirming effect, CHI is working to have the Centering model of care adopted as quickly and widely as possible. Our five-year growth plan will result in an expansion of Centering sites that offer group care from pregnancy to age two (and beyond), particularly in the most vulnerable communities served by Federally Qualified Health Centers (FQHCs) and resource-poor community health clinics (CHCs).

Feasibility: Where are you with understanding the feasibility of your idea? Describe what you’ve done so far and your plans. (3000 characters)

CHI is the standards organization for the Centering care models, and the only organization to offer a continuity model of care through the critical early childhood period of health and development (P-2+). The CenteringPregnancy model is backed by 10 years of clinical evidence showing significant improvements in health outcomes and reductions in healthcare costs. CenteringParenting developed organically as patients and innovative providers demanded the continuity of care in a group setting. Our challenge is to make CenteringParenting the standard of care. To accomplish this we need to increase awareness, provide financial supports to expand access to the families that would benefit most through care at FQHCs and community health centers and accelerate research that builds an evidence base for the impact of Centering on early childhood health outcomes and indicators of school readiness. We have received a financial commitment that would support half of the cost of the three year cluster randomized control trial proposed by Dr. Renee Boynton-Jarrett (contingent on CHI raising the balance of funds needed to cover the remaining costs of the study by June 1, 2018.) We are actively seeking additional funders to support this important study.

Business Viability: How viable is your business model? (5000 characters)

With over two decades of experience, the Centering Healthcare Institute has developed and sustained the Centering group care models in more than 500 practice sites and within some of the largest health systems in the world. CHI has a strong and diversified funding model consisting of earned revenue and foundation funding. We have focused on earned revenue as a primary source of funding with a secondary focus on foundations. We believe this revenue mix has provided CHI with a strong foundation to ensure that our growth strategy has sustained impact over time. Our sustainability is also grounded on the team we have built and practice we have developed to match our funding model. We will continue to evolve our strategy as we grow and learn and continue to impact the lives of children and families. Leadership and collaboration are at the heart of our success. Our team’s strength comes from the variety of expertise, knowledge and skills that staff members bring to their work every day. We have staff with expertise in clinical care, community engagement, public health, business development and policy. In addition, this external facing skillset is enhanced and supported by our financial and IT infrastructure.

HCD: How have you used human centered design to build or refine your concept? (5000 characters)

I was first introduced to the basics of design thinking several years ago by a Centering partner who was visiting in Boston. She led me through the concept and, in the course of an afternoon, we managed to cover my office walls with sticky notes of every color and size. It was over that first experience that I was inspired, curious to learn more and eager to build this methodology into our everyday work. Since that inaugural exercise there have been multiple opportunities to understand more about human centered design and to bring elements of this practice to the entire CHI team. We use this creative approach to problem solving for everything from new product development to customer service improvements and our five year growth strategy. Maybe the best example of how we have embraced human centered design is to walk through our learnings with CenteringParenting over the past several years. This model developed organically as mothers in CenteringPregnancy groups “graduated” after the birth of their babies and insisted that they wanted to continue receiving care in a group visit. Over time the CHI team created a basic curriculum and patient facing materials. A number of innovative health centers jumped in to begin offering well-child group visits. Many of these practices –including the one in Colorado that I wrote about earlier in this challenge– are some of the strongest CenteringParenting ambassadors today. However, the model was not taking off as we had imagined. What were the barriers to widespread adoption? It was apparent that we needed to step back before we could move forward. The first essential step was to spend time with these active CenteringParenting sites. We talked, we visited, we observed and most especially, we listened. We witnessed the magic of Centering in groups across the country. We also heard the objections and limitations of health centers that were not able to implement CenteringParenting. And we learned a lot about ourselves along the way too. We have been continuing these conversations over the past few years and have gained a new understanding of what partnership might look like. Takeaways enabled us to adapt our approach and informed a significant update to our curriculum, patient materials and services. Our staff required additional training and support. We created a national network that brings everyone together in a virtual Centering group format to share best practices, challenges and successes. We were reminded that the barriers to widespread adoption include increased awareness, funding for implementation support and an evidence-base. We are in the implementation stage now. We have the right team and an aggressive plan to spread and scale the Centering model. We have several funder partnerships that are enabling us to launch an implementation grants program to 130 new CenteringParenting sites over the next two years and to employ a robust marketing strategy. We are actively pursuing funding opportunities for Dr. Boynton Jarrett’s research and are confident this study will be the tipping point for CenteringParenting, as we learned with the success of CenteringPregnancy after the initial randomized controlled trial.

Tell us more about you (3000 characters)

I am inspired by the story of a special Centering group at Clinica Family Health Services in Denver, CO. The moms met in their CenteringPregnancy group and connected through the experience of pregnancy and birth. Many were recent immigrants and over time they established a community built on shared experiences and trust. After the babies arrived the group continued on together, with their healthcare team, in CenteringParenting. In the first two years they celebrated all of their baby's milestones, the joys and challenges of parenting, and birthdays. When their group was due to wrap up after the 24 month well-child visit, the parents insisted they wanted to continue receiving their care as a group. Their CenteringParenting group still meets every year for their well-child visits and these fabulous children celebrated their 10th birthdays together in February! It is my honor to serve as the Senior Director of Engagement and Innovation at CHI. In this role I oversee the development of Centering products, services, training and engagement.

As you consider your next steps, what kinds of help could you use? Is there a type of expertise that would be most helpful? (1800 characters)

We would love to collaborate with others in the ECD community! We are always seeking new and innovative ways to enhance our offerings, better support practice sites and develop materials for patients/parents. We have had requests for apps and e-materials. We would also be very happy to share our experiences - and lessons learned - with others.

Would you like mentoring support?

  • Yes

Are you willing to share your email contact information submitted on OpenIDEO with Gary Community Investments?

  • Yes, share my contact information

9 comments

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Photo of Cecilia
Team

I love the concept of CenteringParenting, especially for those without supportive networks and applaud the effort to evaluate its impact on early childhood learning and kindergarten readiness.

Spam
Photo of Marena Burnett
Team

Thanks, Cecilia. Not having the evidence base has been one of the barriers to wide spread adoption of the model. We anticipate this RCT will have a significant impact.

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