Centering Adolescents

1. Centering Adolescents Group Prenatal Care Implementation in a Teen & Tot Clinic: Adaptation and Patient Reception Practicum Intern Sommer Barnes, Maternal & Child Health This program is funded by the Boston Public Health Commission and Boston Healthy Start Initiative

2. Background • Adolescents may be at increased risk of adverse perinatal outcomes, and may be especially vulnerable and susceptible to sexually transmitted diseases and infections • The Teen and Tot Program at Boston Medical Center is a program in Pediatric,s linking pregnant and parenting teenagers (≤21) to educational, social, and healthcare resources at BMC and in the community • CenteringPregnancy is a group model of care in which participants practice self-assessment, health education, and build communities of support during and after pregnancy • The Centering Healthcare Institute is currently developing materials and curricula for Centering groups dedicated to meeting adolescents’ needs

3. Introduction • Implementation of exclusively adolescent CenteringPregnancy program in the Adolescent Clinic at BMC, as part of Teen and Tot Program • 10 sessions, 6-8 teens, 16-20 weeks gestation, mostly African American and Latino in TTP • Practitioners have prior experience with teenagers, and prior experience with Centering, but until now, these have not been combined • Absence of mentoring relationship in mostly primiparous teenage cohort—but perhaps heightened peer support • Discovering “What makes Centering work for teens”

4. Objectives • Improve perinatal outcomes for adolescents • Adapt established strategies for group prenatal care to a completely teenaged cohort • Identify and pilot new care services tailored to teenage mothers’ needs • Monitor patient satisfaction and health indicators to inform future groups

5. Goals • Research established methods and evidence in group prenatal care delivery and outcomes • Research developments in teen-specific materials and curricula • Obtain appropriate materials and aid in adaptation to the Teen & Tot Program • Make recommendations for future adolescent Centering groups at Boston Medical Center • Assist in Monitoring and Evaluation through data collection

6. Activities & Rationale • Conduct literature review of group care, particularly among adolescents to inform direction of research into appropriate methods and activities • Participate in all CenteringPregnancy sessions as a participant-observer to facilitate nonthreatening educational sessions and provide outside input without disrupting the group model • Keep detailed field notes for drawing qualitative analysis of group dynamics & patient attitudes, concerns, and adherence • Obtain materials and curricula for implementing Centering with an all-adolescent cohort • Training in Centering Counts data input for future evaluation of site fidelity and outcomes

8. CenteringPregnancy+ Project • Contraceptives • Family Assessment • Personalization of Risk – HIV/STIs • Staying safe in long-term relationships • Personal Goals • Actual v. ideal risk • Effects of STDs on pregnancy/fetus • STD/HIV myths & facts • “Dear Centering” scenarios • Triggers for unprotected sex • Barriers & benefits to condom use • Condom use instruction • Communication strategies • Safer Sex Goals for My Future

9. Main Findings • Community and Relationship – shared mealtime, using one another’s names, introducing one another to the group, teaching and helping one another with weight measurement, blood pressure, etc. • Teens often cite grandmothers as most supportive of pregnancy • Effect of Support Persons – negativity, inconsistency vs. consistent positive support • Partners’ confusion/understanding of role – fathers are interested but uncomfortable, inquire about group “just for us” • Good feedback from patients, even from those for whom it is emotionally difficult.

10. Importance of established systems, routines, and personnel roles in practical implementation • Need for “drawing out” the quiet ones to make patient-directed care equitable in a group • Reminder: “This is your real prenatal appointment” • Sense of humor • Acknowledging, validating, and encouraging discussion of the good and the bad • Emotional counseling and sharing coping strategies – from facilitator and from one another

11. Recommendations • Incorporate self-esteem and goal orientation into teen curriculum addressing STI/HIV • Compare outcomes of teens in mixed-age groups to outcomes among teen-only groups • Evaluate the effect of partner Support Person upon single group members in a population with lower levels of partner involvement • Incorporate partners and grandmothers as much as possible in STI prevention efforts • Continue to foster partner/father involvement for those who are present • Maintain perseverance with difficult patients

12. “Well, you’re gonna have to fight with me to get out of that tub because I want a water birth!” “Everyone at the shelter is wondering how I can run up and down the stairs so fast. I don’t know, my son is giving me energy.” “I guess it’s hard, like it’s hard to find the right size or shape [of condom]. And it seems like some guys just need to have sex.”