Centering Parenting: Meeting the needs of parents

J. Cyne Johnston, PhD and Cheryl MacLeod, RN MEd

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Outline

• Group Parenting Programs• Centering Parenting• Centering Parenting within AHS

– Development– Implementation– Evaluation

• Future Plans

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Transitions

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Traditional One-to-One Support

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Group Care

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Key Concepts for Group Care

Client and Provider

Satisfaction

Family Centered

Care

Facilitative

EmpowermentPeer Support

Capacity Building

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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)

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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

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Centering Parenting

A model of group care for well-woman and well-baby

» Health assessment» Education» Peer and Professional Support» Immunization

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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

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Maternal and Infant Self-Assessment

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Provider Assessment• Each dyad has an individual assessment with the health provider

• Normal triage done

• Questions are saved for the group session

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Group Session

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• 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

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Paradigm ShiftTraditional 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

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Centering Parenting in Calgary Public Health Clinics

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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

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Adapting to local context

• Curriculum• Vaccination delivery system• Public health nursing led• Visit time points: 1,2,4,6,9,12

months

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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.”

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What have we learned so far…

PHNs were excited about a new model of providing care and having additional opportunities for professional growth.

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Parenting ExpertsThere 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.”

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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

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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?

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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)

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Centering Parenting Calgary Zone

Data Collection Tools, Measures, Health Indicators

Maternal BMI Program costsChild growth Qualitative interviewsSocial support Postpartum depressionParenting moral indexParent and clinician satisfactionParenting stressBreastfeeding initiation/duration

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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.

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Challenges

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Shift in Practice

• Moving from directive to facilitative

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Logistical Issues

• Physical space for a group that’s appropriate for groups of parents and infants

• Scheduling and shift changes

• Recruitment of parents

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Stakeholder Support

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Provincial and International Interest

Considerable interest from:• Alberta Health• Centering Healthcare Institute• Other Alberta Health Services Zones• Primary Care Networks

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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

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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

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Special Thanks

• Alberta Centre for Child, Family and Community Research

• Alberta Health Services• University of Calgary

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Contact Information

Cyne JohnstonCyne.johnston@albertahealthservices.ca

Cheryl MacLeodCheryl.macleod@albertahealthservices.ca