Frequently Asked Questions

How can I bill for CenteringPregnancy groups?

Since physical assessment is a component of Centering, you bill in the same way that you ordinarily bill for prenatal care. Each woman has an individual visit with the provider but it happens within the group space.

How is confidentiality maintained (under HIPAA regulations) within the group care framework?

Group care is always an option for a woman, even though the majority of the women in the practice may be in groups. There is a Confidentiality Agreement which each participant signs, and it is emphasized that a person's particular concerns should not be broached outside the group setting. Each site is encouraged to post ground rules in the group space and review them periodically. Although each woman's chart is in the group space for use by the woman and her provider, there is no general access of others to that chart. The decision to share information with the group is made by each person; no one ever is pressured to disclose personal concerns. Each expectant mom and her partner have some private moments in which to discuss personal concerns with the health care provider, and general topics are then raised within the group for discussion and information sharing.

Will I have enough time to give attention to personal problems of individual patients?

In the quick individual assessment, women will bring topics of concern. These can be handled briefly at that time, but a prolonged discussion of more complicated issues would be postponed until the end of the session. If the problem involves the need for a more private physical assessment, provision for that can be made at the close of the group.

Typically, though, the pregnancy concern of one woman is applicable to many members of the group. In such cases, a complete answer is deferred for group discussion (on an anonymous level, if desired). The woman is encouraged to write to topic on a board or flip chart provided in the discussion space, so that no topic is overlooked that session.

Aren't women self-conscious and/or uncomfortable being examined in front of a group?

This is not a usual concern for women/couples after they understand how the assessment portion of the group will work. Naturally, most of the group time is spent in discussion and learning, with each woman having only 3-5 minutes privately with the care provider.

This assessment takes place off to one side of the room, usually on a mat on the floor. Also occurring simultaneously in the space: soft music is playing, recent arrivals are checking their weight and blood pressure, those already assessed are greeting each other and getting a snack, and some people are filling out the Self Assessment Sheet for that session.

Because each woman (or couple) values her own private time with the provider, no one "hovers" too near the assessment space, but rather she spends that time preparing herself for the support and educational components of the session.

With women taking and recording their own weights and blood pressures, how accurate are the charts?

A pregnant woman has the best interest of her baby at heart, and she is careful about recording her weight and BP.

To help her be as accurate as possible, she is given some important tools to use:

An easy-to-read scale, one that accommodates a growing belly;
An automatic blood pressure cuff, which provides digital information which is easily recorded.
Information so that she understands what these numbers mean, how to develop healthy goals for herself, and ways to meet these goals. If she is able to lower her blood pressure through relaxation techniques or to manage her weight gain by making healthy food choices, she will be empowered to monitor her health and that of her family during her pregnancy and beyond.
A nurse or assistant does the initial instruction in how to use the equipment and then is available to provide additional help as needed.

Can't I use the educational material for childbirth classes, but still maintain an individual assessment schedule with the expectant moms?

The materials in the Notebooks are developed to assist discussion in these facilitated groups and to provide some take-home educational handouts. Self-assessment sheets help the focus concerns and also help to spring the discussion. This is a group model that utilizes a facilitative leadership style that honors basic principles of adult education. It is not a didactic class format and in no way is the group leader viewed as the teacher. Women learn as much or more from other women in the group and this contributes directly to an increasing sense of empowerment exhibited by each woman. Content that is found in traditional childbirth classes is woven throughout the ten Centering sessions eliminating the need for outside classes. Some women, though, will still find them beneficial, especially if their partner is unable to attend the Centering group sessions. Centering eliminates the need for additional "classes"-on topics of childbirth or breastfeeding, for example-but Centering sessions are never a "class." Instead, they are facilitated groups where the women themselves serve as "experts" and their shared knowledge evolves into a collective wisdom. The Self-Assessment Sheets will serve as a starting point for the topic to be discussed that session.

Why can't I continue to do the prenatal checks in an exam room?

Assessment done in a separate place at another time diminishes the advantage of the group care model for women. Exam rooms perpetuate the model of provider control making it more difficult for women to really feel they are in direct partnership with their provider. Exam tables accentuate the power differential and may reinforce past negative experiences that the woman has had on such a table. The Centering model encourages questions to be brought to the group for discussion. It is almost impossible for the provider to remember to do that when in the very familiar space of an exam room. Finally, the checks can be done with minimum exposure and should be done in a private area of the group room. For many populations, there will be an exciting awareness tat the women are all growing in a similar way. For populations that desire more modesty, a privacy screen or large plant may be desirable. If there is a need for a more private assessment, that can be done at a later time in an exam room.

How can I find out more about the Centering model of care?

The Centering Healthcare Institute has several suggestions for moving forward with information and training. First, CHI has an Information Packet, which contains articles, information on the organization, press releases, and the latest edition of the newsletter, Centering Circuit. It is suitable for use with administrators, directors, funding agencies, etc. There also is a CD biz card that contains a PowerPoint presentation on the model.

How do I go about writing a grant for financial support of our program?

Many sites are writing grants to help to cover some of the start-up and on-going expenses of the Centering model. Initial funding is especially helpful to support the consultation and training costs of system redesign and group facilitation work. Local foundations, state agencies, the March of Dimes, Health Start and other organizations have been sources of funding.

We strongly encourage you to contact CHI before preparing a grant proposal. We can assist you with content and with budget items that will provide you with the best possible support for your program. We also encourage you to look for matching funds from the organization to help to assure sustainability of the program. Centering is reimbursable through the regular reimbursement mechanism used for billing by each agency so most on-going costs for the groups should be covered.

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